HRT, also known as hormone replacement therapy, is the use of synthetic hormones to mimic traditional sex hormones. The use of testosterone HRT has been foundational and approved as the best form of treatment for transgender people for nearly a century.
Testosterone is the primary sex hormone that produces “masculine” attributes, such as facial hair, a deepened voice, and higher muscle mass. Testosterone is prescribed to individuals assigned female at birth as part of their gender transition and monitored by their healthcare team to replicate natural testosterone production levels in cisgender men.
Nearly all forms of injectable testosterone are ethers suspended in sesame oil or cottonseed oil that are absorbed slowly by the body due to esterification.
Injectable testosterone comes in TWO forms.
Injectable
Also known as IM, intramuscular shots are the most common form of testosterone prescribed.IM injections use longer, thicker needles to inject testosterone into the muscle.
Intramuscular injections commonly use needles 1” to 1.5” and 21 to 23 gauge. Needle length can vary depending on individual need since the needle must be long enough to puncture the muscle, although gauge size is standard to accommodate testosterone’s viscosity.
“That’s a huge needle! Doesn’t that hurt?!” Actually, IM injections are not nearly as painful as they look. The needle is visually terrifying, but the size does not cause any additional pain compared to subcutaneous injections.
Pain is primarily caused when the needle breaks the skin barrier and activates nerves to notify your body of injury. Once the skin is broken, the needle continues to penetrate down into the fat and muscle – but neither contains nerve endings that will cause pain.
Subcutaneous, or subq, shots use smaller needles to inject testosterone into the subcutaneous fat just underneath the skin. Since subcutaneous injections only penetrate those two layers, they don’t require the length associated with IM injections.
Subq injections are also compatible via self-injectors like Xyosted, a medical pen that is used with your medication to deliver the medication via its spring mechanism. While IM can be done with self-injectors, it is difficult and less common.
Both subcutaneous and intramuscular shots are meant to be self-administered, although it is possible to find a provider or family member to help if you struggle with needle phobia. Since subq injections use smaller needles, folks find them easier to manage.
As noted with intramuscular injections, the pain associated with subq shots will be similar to IM, since pain is largely induced by breaking the skin barrier.
Testosterone can be safely administered via dermal contact through gels, patches, and creams. Transdermal testosterone is applied daily in small doses and absorbed by the body throughout the day.
Hormone Stability and Pharmacokinetics
Pharmacokinetics refers to the effects of the body based on the original administration of a dose, including when it is eliminated and the time for the next dose.
Since bodies assigned female at birth cannot produce testosterone naturally, regular administration is required to maintain proper hormone levels.
One disadvantage of injectable testosterone is the pharmacokinetic cycle, causing hormonal dips and peaks. The day following testosterone injection is when testosterone levels are highest, causing side effects like mood swings and acne. Conversely, levels are lowest immediately before an injection and are associated with irritability and low energy, known as “T drop.” This cycle can be heightened or reduced based on dose frequency – some guys inject their testosterone every week, while others take it once a month.
In contrast, topical testosterone does not present noticeable dips or peaks since it is administered daily. All forms of topical testosterone produce a steady hormone dose with minimal fluctuation.
Is Topical Testosterone Less Effective Than Injections?
“I heard that topical testosterone isn’t as effective as injectable testosterone. Is that true?“ No. Empirical evidence shows that topical testosterone is just as effective as injectable testosterone. This myth is due to anecdotal accounts since many users post their results (or lack thereof) online, creating the illusion that topical testosterone is less effective. Injected testosterone may produce faster results in the first week, but this is completely negated in the following days.
The effectiveness of testosterone is NOT dependent on how it is administered.
Effectiveness is determined based on hormone levels and genetics. When undergoing hormone replacement therapy, a healthcare professional will monitor your hormone levels, and your testosterone prescription will be adjusted based on your levels.
In other words, your provider is going to make sure you obtain optimal hormone levels regardless of whether it is injectable or topical.
If you’re seeking less noticeable results from testosterone, that’s also an option – but you’ll need to find a provider that is knowledgeable in low-dose hormone replacement therapy since it’s not the norm. Again, the administration route does not matter; the lesser results are caused by a lower dose of testosterone for a set amount of time.
Genetics play a significant role in how secondary sex characteristics express themselves during hormone replacement therapy. Regardless of testosterone levels, some cisgender men struggle to ever grow facial hair or get a super deep voice. Testosterone levels influence the pace at which these results will appear, but genetics will cap off aspects like male pattern baldness, erectile tissue size, and body hair.
“Are there any downsides to topical testosterone? Why would anyone choose injectable testosterone instead?” The application route is highly dependent on a variety of factors. Topical testosterone bypasses needle phobia (since there are no needles involved), but it has two main disadvantages.
Topical testosterone must be applied daily. Injectable testosterone is administered once every week, two weeks, or a month. Once injected, you’re free to go and forget about it until it’s time for the next dose. Thus, topical testosterone has a higher upkeep and is not recommended if you’re forgetful.
Secondly, topical testosterone must permeate the skin to be effective. This means you must make sure your hands are completely washed after applying to ensure testosterone does not transfer to other humans or animals, and avoid skin-to-skin contact on the application site even after it has dried. You also have to be wary of swimming, showering, or applying other creams (like sunscreen) on the application site since it will wash or dilute the medication.
As a minor footnote, lots of guys prefer injectable testosterone because it is cheapest. Topical testosterone can be expensive or laborious for insurance to cover.
Need help paying for prescriptions that insurance won’t cover? Try GoodRx.
Testosterone patches work the same way as gels and creams. Once applied, testosterone is absorbed through the skin via an alcohol-based gel in the patch.
Subcutaneous Testosterone Pellets
Pellets are a relatively new form that administers crystalline testosterone implanted beneath the skin.
Testosterone pellets are exceptionally small (about the size of a single grain of rice) and are inserted under local anesthesia every three to four months by a healthcare professional. Unlike other forms of HRT, pellets require visiting your provider to directly administer the medication.
Similar to the dips and peaks mentioned for injectable testosterone, pellets will suffer the same issue. They provide immense convenience since you only have to worry about the application every few months, but you’ll have starker dips during T drop.
“Pellets sound cool! Why haven’t I heard more about them??” Likely because they’re hard to access. Injectable IM and subq testosterone are the standard methods, so you have to go out of your way to request pellets.
Just because a provider prescribes HRT doesn’t mean they’re knowledgeable or comfortable with pellets – so you’ll have to find a provider that specializes in it.
Nasal Testosterone Gel
Natesto is a form of hormone replacement therapy that utilizes a nasal gel to administer testosterone every six to eight hours.
It works similarly to topical testosterone, but it significantly reduces the risk of accidental transfer. On the other hand, nasal testosterone requires more upkeep since it is administered multiple times each day.
Due to how new nasal testosterone is, it’s rare to come across. As of the time of this article, there are no generic versions available and are considered too cost-prohibitive for most folks.
Oral, Sublingual, and Buccal Testosterone
Testosterone is also administrable orally through a pill, BUT it is not recommended for hormone replacement therapy due to how testosterone is compounded and dissolved by the body over time.
The chemical composition of testosterone is frequently modified to improve its functionality and allow the body to better absorb the medication. When modified synthetic testosterone enters the bloodstream, the excess ether compounds are cleaved off during hydrolization and force the testosterone to return to its bioidentical form, similar to naturally occurring hormones, ready to perform its associated tasks. Without the modification, testosterone would not be effective in slowly releasing hormones into the body.
When oral medications are administered, they are first absorbed through the gastrointestinal tract and passed into the liver. Without synthetic modifications, pure bioidentical testosterone is overwhelmingly metabolized through the liver, rendered ineffective. However, synthetic modifications to oral testosterone (such as methyltestosterone) are extremely hard on the liver and considered too toxic for long-term HRT when other safer methods are readily available.
Testosterone undecanoate, another form of oral testosterone, is considered safer but is also not recommended since it is eliminated from the body within a few hours and requires excessively frequent dosages that are expensive on the body and wallet.
Sublingual and buccal testosterone administer medication via dissolving it under the tongue or against the surface of one’s gums. Since it isn’t swallowed, sublingual and buccal testosterone avoids extreme liver toxicity that other forms of oral testosterone cause. Both are virtually impossible to find in the United States.
There are a great deal of scary articles out there that claim testosterone is dangerous. Studies currently show that testosterone-based hormone replacement therapy is safe – although there is a lack of long-term high-quality data to study limitations in previous studies, since long-term studies require… time.
Testosterone does impact your health, but not in any particularly scary way. Cardiovascular issues, sleep apnea, and metabolic changes increase, BUT these changes place transgender men at the exact same risk as cisgender men with naturally occurring testosterone. HRT does not put you at an adverse risk, and monitoring prevents potential issues like polycythemia from happening.
Does brand name matter, or will using generic medication cause inferior results?
No. Pharmaceutical companies will say otherwise, but brand name doesn’t impact HRT effectiveness. The only thing that matters is the active ingredients and dosage.
Does injectable testosterone cause faster results than topical versions?
No. As explained in the topical testosterone section, accounts of injectable testosterone being more effective are anecdotal and not aligned with empirical evidence. Effectiveness of testosterone is determined by dose and HRT level, not administration route.
When will I see the effects of HRT?
That depends on dosage and genetics. Some changes, such as clitorial enlargement and acne, will occur quickly, while things like body hair and hairline changes can happen a decade into HRT. Look at the men in your family and consider how puberty impacted them to predict how HRT will manifest changes.
Packing is the practice of placing an object into the crotch to resemble the look and feel of a penis. Even some cisgender men pack when they feel the need to compensate for their natural bulge. Packing is commonly done by transmasculine people to reduce gender dysphoria and can be completed with a wide variety of devices.
Q: DO I HAVE TO PACK? A:Nope. Many people don’t pack since it’s a personal preference. Packing is not a requirement for being transgender, and there are lots of reasons transmasculine people might choose not to pack.
Q: WHAT SIZE SHOULD I GET? A: Any size works, but most guys prefer packers based on their height and weight. Your packer’s size will affect how you sit, exercise, walk, and move around. Cisgender men typically average at three to four inches while flaccid, but it can also be helpful to compare length and girth based on nationality.
How do I get started with packing?
Packers use either padding or phallic shapes to imitate the bulge of a natural penis. If you have never packed, it can feel strange walking around and getting used to it.
Most folks become acquainted with packing via the sock or gel tube method since both are free.
Sock Packing
There really isn’t a right or wrong way to sock pack. Grab a couple of mid-length socks, roll one inside the other to create a ball shape. Adjust the shape until you’re happy with it. Stick it in your pants. Simple as that.
If you’re wearing briefs or boxer briefs, congrats – your underwear will act as a natural harness to hold the sock packer throughout the day.
Prefer boxers? Any men’s underwear with a non-buttoned flap can have the packer stuck between the fabric flaps and keep the socks from actually touching your skin and causing irritation.
Gel Packing
Once you’re comfortable with sock packing, the next step is gel packing since it better resembles the feel of a penis compared to cloth. Fill a non-lubricated condom with hair gel and tie it off once it’s at a good shaft length. Use additional condoms to double or triple layer the packer, making it stiffer.*
Fill another condom about a quarter of the way with hair gel. Twist the condom and fold it in on itself to create a second layer. Tie it off – you’ve got your first testicle. Repeat these steps to create a second testicle.
Get a pair of nylon pantyhose cutting off one of the legs. Drop the shaft into the toe of the leg and tie it inside. Drop the two testicles into the next part of the pantyhose, tying it firmly and cutting off any loose hose.
Gel packers are surprisingly strong despite how cheap they are to create. To wear a gel packer, you’ll either need well-fitted briefs, boxer briefs, trucks, a jock strap, or a DIY harness. Compared to sock packers, gel packers are more likely to force you to acquire a male gait since there is physically something between your legs.
Gel and sock packers are the simplest forms of packing, but there are hundreds of designs available. Here are the most common types of packers and what makes them unique.
Soft Packers
Soft packers resemble flaccid penises and are best suited for casual everyday use. These packers are typically created from elastomer or silicone, designed solely for creating a bulge. Soft packers cannot be used for sex or urination.
Ironically, soft packers were first mass-produced on the mainstream market as a gag bachelorette gift before being picked up by transmasculine consumers. Soft packers range between $15 to $50 based on material.
Elastomer packers cost significantly less, but are worse for your health since they often contain chemicals that leach into the body through skin contact.
Silicone packers are the community standard since they are body-safe and last for years. The silicone prevents skin irritation despite daily use.
Some folks don’t like the phallic look that packers imitate. Minimal packers are abstract and aim to solely create a bulge without traditional phallic shapes. Depending on how abstract and artsy you’re going for, these can range from $3 to $30.
STPs include any device that allows the user to urinate while standing up, such as at a urinal. Most STPs are STP packers, resembling the shape and color of cisgender penises for optimal stealth while in use. STP packers are the most basic type of prosthetic packer.
Stand-to-pee packers have a learning curve since they incorporate different bowls and seals. Always practice using your STP at home before trying it in public to avoid urine dripping down your jeans. It’s natural to be frustrated while learning the process, so be patient and follow the packer’s instructions and community input.
STP packers require either well-fitted underwear, packing pouches, or a harness to hold the device. Non-anatomical STP devices, on the other hand, usually aren’t and are instead held in one’s pocket or bag.
Always clean your packer. Even if you only use a basic soft packer, it’ll naturally get gross and sweaty since it’s in your crotch. Dirty packers can cause UTIs, infections, and skin irritation.
These packers are where most individuals get confused since some companies refer to them as pack ‘n plays, 2-in-1, 3-in-1, or even 4-in-1. Multifunctional packers are prosthetic devices that are designed for everyday flaccid packing plus one additional function.
The most common multifunctional packer model is the pack ‘n play, which allows you to have penetrative sex with the same packing device that is usually flaccid for casual packing. These packers accomplish this through rods or a valve inflation system to stimulate an erection. Since these packers allow you to pack and have sex, they’re also considered 2-in-1 devices.
Technically, STP packers are ALSO multifunctional 2-in-1s since the two functions are packing and peeing. Again, multifunctional packers are where most folks get confused, so make sure to always read the label on a packer for what its functions are.
The 3-in-1 packer allows the user to casually pack, have penetrative sex, and urinate while standing up with the same device. 3-in-1s are hollow like regular STP packers, but are able to later become erect through a rod system designed for the model.
A 4-in-1 model refers to a packer that packs, acts as an STP, allows for penetrative sex, and sexually stimulates the user during sex. The 4-in-1 label is a marketing gimmick – most 3-in-1s provide sexual stimulation to the user regardless of whether it’s labeled as a 3 or 4. Like the 3-in-1, the 4-in-1 is hollow for everyday packing and STP use. Some 4-in-1s, like the discontinued Freetom, have ridges in the silicone to provide stimulation, while others, like the Peecock, provide stimulation through the rod system.
Rods, rods, rods. Are there any packers that allow you to pack, pee, and have sex without rods? Not yet, unfortunately. The Bionic was the closest device to solve this conundrum, but the project has been mostly discontinued.If you’re looking for a rod-less packer but don’t need to urinate standing up, the Peecock Inflatable uses the basic idea of the Bionic to incorporate air valves.
Compared to binders, there aren’t as many organizations that offer packer charities. On the other hand, packers can be safely created DIY-style, unlike chest binders.
The Queer Trans Project offers a set number of Build-a-Queer Kits throughout the year based on donations. The kits include a variety of items, like packers and binders, based on individual need.
The Thrive Fund is a general fund operated by Point of Pride for folks who don’t fall under their other scholarships for surgery, binders, HRT, shapewear, or electrolysis.
Albeit not free, transgender groups are a great option to buy pre-owned items. Multifunctional packers are expensive! While buy/sell/trades exist on all social media platforms, make sure you’re using a reputable one like r/ftm.
Every person deserves support. Transgender people are no exception. But where do you find information, resources, and tools? With thousands of websites out there, getting connected can feel overwhelming. Here are ten important transgender websites you should be aware of.
Advocates for Trans Equality
A4TE was formed in 2024 when the National Center for Transgender Equality and Transgender Legal Defense and Education Fund merged. For transgender Americans, A4TE might be the most important organization to be aware of.
Transgender people deserve access to healthcare. The Trans Health Project by A4TE guides users through understanding trans-inclusive (and exclusive) coverage through the American insurance industry, how to get a letter of medical necessity, and a hub of directories (like OutCare) for finding a trans-friendly healthcare provider.
Each state has different regulations regarding transgender healthcare. The Project includes information regarding each state, as well as Medicaid policies. It also provides templates to give to your provider, easing the insurance process with checklists and letter formats, as well as appeal templates if your insurance company disagrees that your care should be covered.
ID Document Center
You don’t need a law degree to legally change your name or gender marker. Regardless, it can feel like you should – updating your documents is complicated and you’ll have to navigate a complex system with forms, deadlines, and meetings.
The ID Document Center explains the processes behind updating one’sinformation on birth certificate, driver’s license, state ID, passports, social security, immigration documents, and selective service based on the individual state.
Name Change Project
Low-income individuals in select cities are eligible for pro bono legal name change services through A4TE and its partners. Eligible applicants are connected with law firms and corporate legal departments local to their region. At the time of this article, A4TE’s Name Change Project services individuals in the following cities:
Atlanta, Georgia
Chicago, Illinois
New York City (all five boroughs in New York and Bergen, Essex, Hudson, Passaic, Union, and Middlesex counties in New Jersey)
Long Island, New York
Philadelphia, Pennsylvania
Pittsburgh, Pennsylvania
If you live outside of the above cities, you can still find assistance through organizations listed in A4TE’s Trans Legal Services Network.
And Other Incredible Services
A4TE takes on a small number of critical court cases each year to establish new legal precedents regarding transgender law. Impact litigation services are generally unrelated to ID cases that would otherwise be covered in the ID Document Center.
Folks residing in the United States or Canada can utilize Trans Lifeline, a grassroots nonprofit that operates an anonymous and confidential hotline for trans people, by trans people.
Unlike other crisis services (such as 988), Trans Lifeline does not use nonconsensual active rescue and will not call emergency services or law enforcement without the explicit consent of the caller. They’re also not affiliated with the federal government and cannot be impacted by federal attacks, such as those targeting the Trevor Project or 988.
Trans Lifeline also hosts a Resource Library, which contains resources that are unlikely to be found elsewhere, such as information on police abolition and community safety.
Originally known as TS Road Map, the Transgender Map has existed online since 1998 and contains over 2,000 pages of researched content to guide visitors through trans-related topics.
It’s regularly updated through the massive undertaking of one individual. Coming out advice, HRT, clothing, voice training, disclosure, handwriting, documents, marriage, films, forums… Transgender Map covers nearly everything you could think of when it comes to transitioning.
Are there books you want to read but don’t have access to? Transgender media isn’t frequently distributed through major publishers, so readers are forced to purchase literature when these items are not available in local libraries. Trans Reads is the community-driven solution to make transgender books accessible.
As a digital community library, anyone can upload content for Trans Reads’ librarians to curate. All items are publicly available at all times. The only downside to the site is its sorting, and it contains thousands of pieces that you’ll have to search through. While Trans Reads offers some reading lists, there aren’t many – its librarians are focused on collecting and uploading items, so you have to know what you’re looking for ahead of time.
Interested in more free clear web virtual libraries?
Internet Archive / Originally created as a library in 1996, the Internet Archive uses web crawlers to collect as much data as possible to provide “universal access to information.” Items can be virtually borrowed with a free account.
Library Genesis (aka LibGen) / The most well-known shadow library on the clear web. Due to constant attacks and takedowns by the federal government since shadow libraries disperse paywalled content for free, you might have to search for its current URL or mirror.
Audiobook Bay / Similar to The Pirate Bay, generally safe, but use with caution. Check the website’s Reddit to find the most current mirror. To access Audiobook Bay, you’ll likely need a VPN like Proton.
Project Gutenberg / PG is the oldest digital library and has provided books via open format files since 1971. Out of all of the libraries listed, it’s the easiest to access since all of its items are public domain and therefore not subject to copyright takedowns.
Queer Liberation Library / QLL offers books through its free account system, and its site is great when used in tandem with others like Trans Reads, since its librarians offer a ton of book suggestions.
Digital Transgender Archive
DTA is the world’s largest trans-focused online archive. It contains thousands of items similar to the Internet Archive before the 2000s, hosting uploaded books, artworks, publications, audio recordings, and films.
The Digital Transgender Archive is the best place to research transgender history, especially in tandem with the Internet Archive. Items date back to the 1500s up to modern day.
Strands for Trans
Many transgender and nonbinary people feel uncomfortable going to salons or barbershops. Hair plays a role in gender expression and our ability to feel represented. However, salons and barbershops have gendered expectations – so there’s little way to know if a stylist will be transgender-friendly.
Strands For Trans is a data map that allows visitors to locate self-identified transgender-friendly salons and barbershops. To be eligible, businesses have to submit their application for review through the Strands For Trans website, similar to Everywhere Is Queer.
REFUGE
Using archival data from Safe2Pee, REFUGE is a community data map that shows transgender-friendly restrooms. Visitors upload and pinpoint safe locations to help their peers feel comfortable.
Unlike other maps, REFUGE leans heavily into user experiences – so it’s easier to know if a location is genuinely trans-friendly based on other transgender people’s experiences.
Erin in the Morning
Erin Reed is an American journalist who provides daily updates on transgender-relevant news and legislation. Her videos are bite-sized and easy to digest; her substack and newsletters are detailed and researched. Stay aware of ongoing attacks on trans rights as well as victories, subscribe to Erin in some way to be connected to the national picture.
In addition to daily content, Erin also manages two maps of interest. The National Risk Assessment Map visualizes anti-transgender legislation for transgender adults and youth to better understand safety risks. Erin’s Informed Consent HRT Map is a public pin map of known informed consent HRT providers throughout the United States.
Similarly, the Movement Advancement Project (MAP) is an independent think tank that visualizes legislation on a larger range of issues. MAP’s data is updated less frequently than Erin’s, but covers more topics like bathroom laws, healthcare regulations, name change protocols, and religious exemptions.
The Transgender Legislation Tracker visualizes and tracks transgender-related legislation throughout the United States. Each state is accounted for, showing currently proposed, passed, and active bills, as well as federal legislation. Erin in the Morning is best used to digest and understand these bills, but the Transgender Legislation Tracker directs you to the actual legislation.
Turn Me Into…
The following sites are great resources for individuals who are questioning their gender or are early in their transition. In a society that demonizes transness, it’s easy to feel conflicted or uncertain. All of the following sites debunk common myths and walk visitors through the questioning process.
The Gender Dysphoria Bible is another great resource. The “Turn Me Into” websites are shorter and cover general topics many questioning folk have early in the process. The Gender Dysphoria Bible, on the other hand, is extensive. Similar to the Lesbian Comphet Masterdoc, the Gender Dysphoria Bible touches on ideas you probably didn’t consider related to trans identity.
And as an honorable mention, the Pronoun Dressing Room is good for folks experimenting with pronouns, names, and gendered titles. The site allows users to try out identities without needing to come out publicly or use social media accounts.
Reddit
On its own, Reddit is a BEAST. It’s a collection of communities that use forums to chat. Reddit is used by all sorts of people – right-wingers, leftists, liberals, apolitical types. Heck, even my grandmother uses Reddit. Compared to traditional platforms like Facebook, Reddit allows for greater anonymity and niche communities.
There are millions of subreddits (individual communities or forums) out there. There are thousands of trans-specific subreddits, so I can safely promise there is a community out there for you. These are the largest and most generalized three for trans folks.
Binding, or the practice of compressing one’s chest to have a flatter and traditionally masculine appearance, is a pretty standard practice amongst the trans community, similar to packing and tucking. Anyone can bind – even if you’re not transgender, there might be moments when it’s beneficial, like if you’re cisgender but engage in cosplay or drag.
In the transmasculine community, binding is one of the first steps in transitioning. Being assigned female at birth, breast tissue naturally forms during natal puberty and creates distress from gender dysphoria unless preventative measures are taken, like puberty blockers. When trans men begin testosterone through prescribed hormone replacement therapy, breast tissue no longer forms – but HRT cannot reverse tissue already created.* Since few transgender people have the fortune to have supportive parents and the ability to access puberty blockers as youth, binding is the norm.
*Technically, testosterone-based hormone replacement therapy CAN impact breast tissue, but it cannot get rid of it entirely. It’s all extremely anecdotal, but you might experience breast tissue shrink in size. More commonly, HRT affects the composition of breast tissue and makes it less firm, similar to breast tissue cisgender men have. However, these changes are rarely enough to override the need for binding.
Q: DO I HAVE TO BIND? A: Nope! While binding is common, it is not a requirement to be transgender, and there are many reasons transmasculine folks may choose not to bind, such as having a chest too large for traditional binders, disability, or comfort. Generally, you should talk with your doctor before binding if you have asthma, scoliosis, lupus, COPD, arthritis, Hypermobility Joint Disorder, GERD/IBS/IBD, migraines, TMJD, or fibromyalgia.
Q: HOW OLD DO I HAVE TO BE TO BIND? A: Anyone who has breast tissue is old enough to bind, although this statement might make people queasy. American youth are entering puberty earlier than ever, so it’s reasonable to say that if breast tissue is causing them significant discomfort, they should have access to binding. While binding can have long-term consequences, preventing kids from binding safely will only make them more likely to DIY, which can be dangerous. On the other end of the spectrum, there’s no upper age cap for binding.
Q: WAIT, DID YOU SAY THERE ARE LONG-TERM CONSEQUENCES TO BINDING? A: Yes, but those consequences come with caveats. Long-term binding can impact the density of your breast tissue, which can potentially limit your options for chest surgery later. However, these effects (which are common at 10+ years of binding) do not bar you from chest surgery – and it’s worth stating that the average transmasculine person gets chest surgery way before this deadline.
There are plenty of anti-trans parents who will rant on how chest binding will impact children’s bone development during puberty, so youth shouldn’t be allowed to bind. While it is a possibility, there isn’t research to back up this claim: there is little long-term research on transgender people as a whole, and even less on minors. Chest binding, when done safely, isn’t dangerous – a binder should feel like a relatively tight hug and should never cause pain. You should also never wear two or more binders, since the added compression can cause a lot of pain. Exceeding safety recommendations puts you at actual risk of developing skeletal issues, and as mentioned above, barring safe binders from youth pushes them to resort to DIY methods with higher risk.
Always get the right size.
Yes, a smaller binder will give you a flatter chest – but the right size vastly minimizes your risk of common side effects. Keep in mind that cisgender men don’t have completely flat chests, and everyone has some breast tissue. Don’t strive for a perfectly flat chest.
DON’T KNOW YOUR BINDER SIZE? FOLLOW THESE STEPS.
Wrap a tape measure around the fullest part of your chest. This is the part that comes out the farthest from your body. Do this while you are dressed.
Write down the measurement. You might want to measure more than once to check it.
Wrap the tape measure around your chest, right under your breasts. This is where the crease is.
Write down the measurement.
Add the measurements together and divide by 2. This is your chest size.
Put the end of the tape at the outside edge of one of your shoulders. Measure across your body to the outside edge of your other shoulder. Make sure you are standing up straight. Avoid tensing up, hunching your shoulders, or wrapping the measuring tape around your shoulders.
Write down the number you get. This is your shoulder size.
If your shoulder measurement is 1.5 inches bigger than the shoulder measurements listed for your chest size… Buy a larger size, usually the next size up.
If your shoulder measurement is smaller than the shoulder measurements for your chest size… Buy the size that matches your chest measurement.
If you have a larger chest or broad shoulders… Consider a tank binder. This might be the most comfortable style for you.
If you buy a binder that is smaller than your measurements… Return it for one that fits. The effect on your chest is probably not enough to notice, and the wrong size puts pressure on your back and ribs.
Wearing the correct binder size MATTERS. Over time, using the incorrect size can restrict breathing, irritate the skin, break skin around the edges of the binder, cause overheating, and bruise/fracture the ribs.
TYPES OF BINDERS
Full-Length Tank As one of the two main classics, the full-length or tank binder has a long panel of compression and can be tucked into your pants. They compress more than just the chest – they also flatten the hips and stomach, which is why these are the most common binders used by cisgender men.
Full-lengths are best suited for individuals with large chests or folks who want additional compression around the stomach and hips. Newer tank binders are made to look like casual shirts, which is a benefit you won’t find with other binder styles. On the other hand, I’ve been told that the more a binder resembles a regular tank top, the less compression it offers. They’re also far less comfortable – from personal experience, full-tanks are hotter and irritating to wear, and I was never able to get the hang of tucking them in, so it would always roll back up.
Half-Length The other classic binder is the half-length, which is identical to the full-length, other than the lack of material. These stop above the ribs, so they’re cooler and allow for a greater range of motion.
Half-lengths are ideal for individuals with smaller chests compared to full-length, but they can work for folks with larger chests if you’re okay with less compression. They offer better breathability, so they’re more comfortable for all-day use and sports. On the other hand, half-lengths are the most well-known – people will know you’re wearing a chest binder unless you cover it up with a shirt.
Racerback The racerback binder came into style within the last decade, offering even more range of motion than the half-tank. They’re identical to the traditional half-tank other than the back support design resembling the same ‘x’ pattern that racerback sports bras use. The same pros and cons apply to these as half-tanks, but their strap design is easier to conceal for folks who don’t want to possibly out themselves for wearing a binder.
Strapless Strapless binders are the most commonly portrayed in film when depicting transmasculine characters, but they’re far from the most commonly worn by actual transgender people.
These are often the cheapest since they’re made in mass production for cosplay, but they offer significantly less compression and support than other binder styles. You have to be precise with strapless measurements, too, since the wrong size could mean the binder falling off. These are also difficult to find by major binder brands due to their association.
I’ll also note that strapless binders like these are considered less safe than other styles – they’re created for cosplay purposes and worn for a day or two at a time, not regular long-term binding. They’re easy to access, but always use with caution.
Pullover & Zipper These aren’t binder styles themselves, but refer to another aspect of all of the above types. A pullover binder will be pulled over your head, similar to a t-shirt, whereas a zipper binder uses a zipper, clasps, or hooks to put the binder around your chest.
Both are good options! Pullover binders are more commonly produced by binder brands since they’re associated with better compression, but they’re difficult to put on in the beginning when you’re new to binding. Zipper binders are common for strapless and cosplay binders, but they’re a better option if you struggle to get pullovers on. However, always opt for zipper binders that attach in the center of your chest or back – zipper binders that attach on just one side will cause uneven compression that can harm your body over time.
Kinetic Tape Kinesiology tape, or K-tape, is a thin elastic tape that uses adhesive, and it’s become fairly popular for binding amongst smaller chested individuals. You should NEVER use other forms of tape to bind, such as duct tape, since K-tape is made specifically for athletic purposes and provides a range of motion and breathability that other tape does not. Duct tape is especially dangerous since it constricts your breathing after application.
K-tape struggles to provide the same level of binding as traditional binders, but many folks find it empowering since it gives a more natural look compared to binders. You can even safely sleep and shower with it since the tape is relatively waterproof and takes a few days to naturally lose its grip.
If you have the funds, there are a number of K-tapes now produced with chest binding in mind – like Trans Tape. While the function is the same, I’ve heard that the quality of Trans Tape is significantly better, BUT regular K-tape is pretty accessible since anyone can purchase it in their local Walmart.
Despite this, kinetic tape isn’t for everyone. The compression level isn’t feasible for many, but more often, it’s the adhesive. Kinetic tapes, regardless of brand, can cause significant irritation to the skin even if you don’t have any adhesive allergies. Later on, I’ll be talking about the importance of binder hygiene, and the same applies here. K-tape is used in a sweaty and hot part of the body that creates a LOT of friction. While I was pleased with the compression K-tape provided me, the tape chafed me pretty badly, and I *don’t* have any adhesive allergies.
Sports Bra A good sports bra can provide a decent level of compression, so it’s a great alternative to regular binding to give your body breaks. In essence, sports bras are similar to racerback binders. Unlike binders, you can find sports bras sold pretty much anywhere, so they’re more accessible.
Unlike the above binding options, sports bras are the ONLY style that I would okay “double-binding.” Since sports bras offer less compression than actual binders, the compression level achieved from double-layering won’t cause significant harm, like if you layered traditional binders.
Keep it clean!
Binders are underwear. Seriously, they can get gross – they’re directly compressing your body and creating hot and humid spaces. Regardless of season, binders should be washed at least weekly, but you should move to every three days if it’s summer or you’re a naturally sweaty person. Even if the binder doesn’t smell too bad, poor binder hygiene causes rashes, skin irritation, acne, fungal infections, and other conditions.
Each binder manufacturer will provide specific instructions on how to best care for your binder. Follow their advice to prolong the life of your binder! However, if you lost the instructions, these are the most common suggestions.
Wash your binder in cold water on a delicate cycle, OR wash it by hand in the sink with laundry detergent and warm water. Avoid hot water and putting your binder in the dryer.
Hang the binder up to dry.
Keep your binder on a hanger when you are not wearing it. This helps it keep its shape.
Have more than one binder, if possible. This allows you to wash and dry them regularly.
Stay flexible and give your body breaks.
Listen to your body – what works for your friend won’t inherently work for you. The following are general guidelines, but always listen to your own body first. If you’re in pain, stop.
Keep binding for eight hours at a time and never bind more than twelve consecutive hours. This can be difficult to navigate if you’re in public often, but it’s best practice to have off days when you do not bind.
Take at least one day completely free of binding per week, and take more break days if you can manage.
Never sleep in your binder. Breathing becomes more shallow while you’re unconscious, so binding while asleep poses an increased risk.
Take precautions if binding while working out or swimming. There are binders available to purchase to use while swimming, since chlorine exposure can shorten traditional binders’ lifespans, and exercise binders that provide greater mobility. If these aren’t options for you, your dedicated workout or swimming binder should be at least one size larger than what you typically wear.
Stay hydrated and keep cool when binding, especially during summer months. Even if you feel fine, it’s pretty easy to develop heat stroke – from personal experience, I got heat exhaustion once while on a summer field trip because I thought it was a myth.
Never use any material to bind that was not listed here. Do not use duct tape, plastic wrap, belts, or ACE bandages. These constrict as you breathe, which can bruise you or potentially suffocate you.
Consider wearing a cotton undershirt or tank top under your binder if your skin is prone to irritation. Binders won’t help any existing skin conditions. An undershirt or the use of body powder also helps during warm weather to limit excess sweating.
Learn exercises and stretches to ease pain in your back, shoulders, and chest. Try stretching every few hours while binding.
Looking for binder suggestions?
The following prices are based on the current price at the time this article was published. Verify with the merchant before buying.
Wait! I want a new binder, but there are too many options! Yeah, and there are plenty of binder brands that I don’t cover below – if you hear good things about a binder company from friends or those you trust, go for it and don’t let my lack of review stop you. Otherwise…
Generally overwhelmed and just need a good quality binder? Get GC2B.
Unable to find a binder size that fits? Get Origami Customs.
Have severe dysphoria and need high compression? Get Underworks.
Looking for something special to be proud of? Get ShapeShifters.
Can’t deal with sensory overload? Get GenderBender or Amor Sensory.
GC2B @ gc2b.co / $42 USD Founded in 2015 as a trans-operated binding brand, GC2B is the premier binder today. After using an Underworks binder, I found GC2B much more comfortable in comparison – although it provided slightly less compression. There’s talk that GC2B binders have gone downhill in quality after they changed textile suppliers, but I’m still a strong supporter of the brand as a whole.
GC2B has a bit of everything, including K-tape. They specialize in everyday binders, so you’ll find a variety of nude binders designed to be concealed under shirts. Before GC2B, binders were only available in white, black, and a limited number of “nude” binders – but the binder color matters significantly if you’re wanting to wear a white shirt. Their binder utilizes both the front and back panels to provide medium compression.
FLAVNT @ flavnt.com / $55 USD This streetwear brand has a larger range of nude binders than GC2B and has a pretty good selection of pride apparel. Their binders are all pullover style and offer medium compression via the front panel. Tired of hideous rainbow merch from retailers like Target and Walmart? Try FLAVNT.
For Them @ forthem.com / $55-$64 USD This brand specializes in underwear, including binders. For Them produces two types, one labeled “MAX” to offer high compression and “All-Day” that prioritizes comfort.
The MAX binder will provide compression similar to other brands, but the All-Day line is unique: it’s made with sensory issues in mind. It won’t make you as flat as other binders, but it’s super comfortable.
Peecock Products @ peecockproducts.com / $31-$34 USD Based out of Singapore, Peecock has been producing chest binders since 2010 and also has one of the best quality of entry-level prosthetic packers out there. Zippers, pullovers, v-necks, swimming binders, you name it – Peecock probably has what you’re looking for. However, their binders won’t be as comfortable or sensory-friendly as GC2B.
TomboyX @ tomboyx.com / $49 USD Although TomboyX caters to femme-identified people, they have a decent binder selection since a large chunk of their customer base is butch. Their selling point is their adjustable binder, which uses straps to allow the user to modify the level of compression. On the other hand, TomboyX binders have lighter compression compared to other brands.
UNTAG @ untag.com / $61-$69 USD Preferred by folks living overseas, UNTAG has a diverse binder selection that offers lower shipping rates compared to some American brands. In addition to the regular selection of binders, UNTAG also offers binders specifically made to exercise and unique designs like lace.
Urbody @ urbody.co / $45-$55 USD These binders were created to further expand binding beyond masculine-identified folks, so they generally offer less compression than other binders. Despite that, Urbody binders are preferred with folks with compression or sensory issues since the lack of compression means increased comfort.
Underworks @ underworks.com / $32-$38 USD As the oldest brand on this list, Underworks is a classic alongside T-Kingdom – they’ve been around since 1997. Originally, their target audience was cisgender men who wanted to compress their torsos, but they transitioned to make an array of trans-friendly binders since Underworks was the easiest place to purchase online.
If you’re looking for high compression, Underworks is for you. Seriously, their compression is INTENSE – but this means their binders can also be uncomfortable. The material is also rougher than brands like GC2B and Origami.
GenderBender @ genderbenderllc.com / $49-$59 USD These guys are relatively new, but they have a great selection that makes them distinct from other brands, like their own brand of K-tape, pride-themed binders, and plus-sized binding swimwear. Their company is disability-centered, so their products are made with various disabilities in mind, like sensory issues, anxiety, adhesive allergies, and the like.
Origami Customs @ origamicustoms.com / $64 USD In addition to the regular selection of binders, Origami Customs is unique because they can and will make custom binders on order. If you are too large for other binder companies, Origami Customs should be your go-to. Without them, people would be barred from binding due to weight or breast size – but Origami Customs can provide anyone with a binder.
Origami Customs also has ready-to-order binders, but I wouldn’t really recommend them if you don’t require a custom size.
Shapeshifters @ shapeshifters.co / $85-$115 USD Most binders are boring since they cater to everyday wear and stealth. Not Shapeshifters binders – they don’t actually have any nude binders unless you’re ordering from their “Make Your Own Binder” sewing kit. Shapeshifters specialize in fashionable designs, offering a refreshing alternative to bland options and asking, ‘Why can’t binders be fun too?!’
However, Shapeshifters is pricier than other brands, so I wouldn’t recommend them as your first binder unless you have money to burn.
Amor Sensory @ amorsensory.com / $79 USD Similar to GenderBender, Amor Sensory is a disability-first binder brand that centers on Autistic experiences. Binding can be a sensory nightmare, so Amor’s binders are sewn with those issues in mind. Even though they cost a bit more, Amor Sensory binders offer trustworthy moderate compression like mainstream brands.
Reddit and Online Spaces @ r/ftm / FREE to ∞ If you don’t mind used binders, check out virtual spaces like r/ftm – they host recurring spaces to allow guys to buy, sell, and trade items and you’ll likely find a used or free binder faster than the binder programs I suggest below. You can find these types of spaces on any forum, including Facebook groups and trans-related Discord servers.
I can’t afford a binder, what should I do?
Fret not, because there’s still options out there! Before continuing with my suggestions, read my last point on binder brands – in my experience, you’ll get a binder faster from online spaces like r/ftm when there’s availability. The companies and organizations I list below give binders as donations, which means they have limited resources and funding and MASSIVE waitlists.
Generally speaking, the larger the organization, the longer the waitlist. My very first binder was a donation from Point of Pride, but I had to wait nine months on their waitlist before it was shipped. These resources are national, but if possible, you should check with any local LGBTQIA+ organization in your area to see if they have a binder program. CenterLink hosts a (incomplete) directory of LGBTQIA+ nonprofits throughout the country, so start there if you don’t know where to begin.
Keep in mind that the following programs are active at the time this article was published. In my experience, binder programs tend to be unstable since they rely on donation funding – so some might be no longer active by the time you’re reading, or there might some missing that you expected to see.
Point of Pride @ pointofpride.org With a variety of funds, Point of Pride has given nearly $4 million dollars to financial aid programs to benefit transgender folks.
They were created in 2016 by Point 5cc, a trans clothing and apparel company to become the first and largest international chest binder donation program. Check out their website for details on their binder program, femme shapewear and gaff program, electrolysis support fund, HRT access fund, trans surgery fund, and Thrive fund. Their binder program is open to all, regardless of age or where they live in the world.
Trans Essentials @ ftmessentials.com Similar to Transguy Supply, Trans Essentials is an online megastore for trans needs. They sell binders, tucking tape, packers, gaffs, dilators, STPs, books, buttons, etc. They also operate Early to Bed for adult goods.
TE provides free Underworks binders to individuals ages 24 and under anywhere in the United States, shipped out on a quarterly basis.
TOMSCOUT @ tomscout.com The Freedom Binder Program provides binders to “storytellers,” determining eligibility based on your personal story and need for a binder.
Make sure to read all of TOMSCOUT’s rules before applying, since missing one will automatically disqualify you. There is no upper age cap, but applicants must be at least sixteen to qualify. Additionally, you’ll have to cover the shipping costs of the binder once you’ve been selected.
The Queer Trans Project @ queertransproject.org Based out of Florida, QTP is a Black-led organization that donates binders, packers, and packing underwear to individuals in need.
QTP has high demand, but they cover a lot of needs – including flight assistance to help transgender folks flee hostile states like Florida for safer havens.
Black Trans Men Inc @ blacktransmen.org The Brother 2 Brother Binder Grant allows Black Trans Men Inc to give free binders to low-income transgender men of color throughout the US.
To qualify, you must be at least sixteen years old, identify as transmasculine, demonstrate financial hardship, and identify as Black. There are no upper age cut-offs for their program. If you don’t identify as Black, they can still help if you reach out by referring you to other applicable programs.
Health Care Advocates International @ hcaillc.com Healthcare access isn’t equal to everyone, which is something marginalized people know well. HACI believes every patient deserves their best chance at a health life.
You must be at least eighteen years olds to qualify for HACI binders. Individuals must be in the United States or Puerto Rico to receive a binder from their services.
Thriving Transmen of Color @ thrivingtransmenofcolor.org TTMOC is a national grassroot nonprofit with chapters in Virginia, Georgia, District of Columbia, California, Florida, Illinois, and Nevada. Like Black Trans Men Inc, TTMOC centers on uplifting Black and Brown transgender individuals.
TTMOC binders are provided based on eligibility and are reserved only for transmasculine individuals who cannot afford to purchase their own binder. Applicants must be following TTMOC on social media and have attended at least one virtual or in-person event to qualify.
Phoenix Transition Program @ phoenixtransitionprogram.org PTP offers direct assistance to transgender folks in need, such as their binder program, care packages, utilities assistance, opening businesses, and crises.
To qualify, you must be at least eighteen years old and live in the United States. Other programs beyond binder assistance are functioning, but are limited based on time of year.
I was 14 when I realized I was transgender, back in the year 2014. Not much later, to my dismay, Caitlyn Jenner came out to the world – her novel identity fascinated the world, and that extended to my hometown in rural America. Suddenly, peers at school were talking about what they supposedly knew about transgender people, and my parents, who wouldn’t know I identified as trans for another year.
I’m well-versed in trans misinformation. Frankly, most transgender people are: it comes with being a marginalized person, expected to educate every single person you meet with unwavering patience. I don’t fault folks who get exhausted and frustrated after years of educating their friends, family, and strangers – that exhaustion led to the rise of Buzzfeed-like “Dear Cis People,” “100 Questions for White People,” and similar articles, videos, and posts during the 2010s that tried to rephrase that expectation. I always wondered when I would become frustrated and exhausted, likely to lash out like a stereotypical “blue-hair liberal.” Yet, eleven years later, I haven’t gotten to that point even though I’ve spent a decade in activism and educating cisgender people throughout those years. I can still manage patience, under one condition: I do not educate for bad faith. Many individuals purposely spread disinformation and “want to ask questions” to trans folks with the express purpose of being the Devil’s advocate. Those individuals are not open to actually learning and come with an agenda to demean or “convert” trans people. You cannot change them in one conversation, and they are not worth the effort. Anyone actually interested in understanding transness, that is not coming from a place of hatred, is worth teaching – even if they stumble on their journey.
Today, there’s more disinformation online than misinformation. There is a semantic difference: misinformation is false info spread, regardless of whether the person sharing knows if it’s true or not, while disinformation is purposely shared with knowledge that the info is false. All disinformation is misinformation, but disinformation is more nefarious. A family relative who shares a misleading post on Facebook about transgender people might not know its facts are wrong – that’s misinformation. If that relative knows that the post is incorrect, it becomes disinformation. There’s another conversation to be had on how to correct people with misinformation, since people hate being told they’re wrong and take corrections as a personal attack. Misinformation wasn’t that big of a deal ten years ago when flat-earthers and autism moms against vaccines were laughingstocks.
Misinformation is a big deal, and I don’t mean to be an alarmist. It truly holds the potential to cost human lives. We are more familiar with current events, such as the effects of misinformation about the COVID vaccine pushing more Americans to forgo the vaccination, leading to more immunocompromised people dying and more healthy Americans suffering from “long COVID.” Or, when Russia hacked American media during the past election cycles to spread disinformation and seat Republican candidates better suited to their interests.
Even before the 20th century, transgender people have always been around. If you look hard enough, you can find traces of gender-diverse people spanning centuries and Roman emperoress Elagabalus. Transness was only recently documented, and it’s only entered the public subconscious and mainstream in the past couple of decades. People claim the same about how many queer people exist today compared to fifty years ago, or how autism is supposedly on the rise. When identities are no longer criminalized and it becomes okay for people to publicly identify themselves, people incorrectly assume there’s an “explosion” of people suddenly queer, autistic, or transgender. The same belief was held on a sudden rise years ago of people identifying as left-handed or folks being diabetic. There was never a real increase, but there was a perceived explosion of left-handed individuals because they weren’t being burned at the stake for writing differently, and people were able to survive diabetes with the discovery of synthetic insulin, creating a “spike” of diabetic people.
This myth is fairly easy to dispute, for now. In some countries, information is regulated: when governments censor topics in published books, movies, and content on the internet, it’s easy to convince people that transgender people don’t exist. We are not at that point yet in the United States, but the GOP does want to move towards that future, evidenced by forced removals of transgender people mentioned in history, research, and educational curricula. Thus, trans history matters.
Myth #2: Transgender regret is common.
Compared to other medical procedures, transgender services like hormone replacement therapy and surgery actually have astonishingly low regret rates. Every surgery has a regret rate, whether it’s from complications, lack of satisfaction, or another reason entirely. The average knee surgery has a regret rate upwards of 30%, breast implants maintain a regret rate of up to 47%, and successful pregnancies have a regret rate around 17%.
The reason transgender people have an astonishingly low regret rate is because of these hoops, but it also deters people from getting care when it could benefit them. Trans regret only gets media coverage because detransitioners become viral on the internet from their sob stories. It’s unfortunate when it actually happens, but stories from detransitioned folks of how they were tricked are made up: even in “fast” informed-consent, you have a barrage of questions to answer from doctors to access prescriptions, changes take weeks to show even minor things, and you have people with you throughout the process to check in. Despite this reality, the belief that medical professionals are diabolically trying to force people to be transgender gets clicks.
Another way to think about trans regret and medical care is to compare it to other services. All procedures have risks and there can always be complications. Those risks are not worth denying the service as a whole. It’d be impossible to fathom a world where cancer treatments are banned because a small percentage of people have negative experiences on a life-saving treatment; the same should be applied to transgender procedures since they are documented as life-saving, too.
Myth #3: Transgender people want to trick cisgender people.
This myth has numerous layers, but at its core, it’s the insecure and paranoid belief that transgender people want to trick cisgender folks into having sex or that transgender people get some joy out of “tricking” people into perceiving us as our affirmed gender. Transgender people want to be respected as their authentic selves, but we don’t get joy from “tricking” others like our identity is a prank.
Trans people tricking poor cisgender folks into having sex is a real problem – and it’s been used as the punchline trope in comedy for decades. It even has legal recognition in most states, referred to as “trans panic defenses,” where cisgender people accused of murdering a transgender person can legally claim they were so angry, upset, or shocked that someone was transgender that they just had to assault them. The legal procedure comes from the underlying fragility of cisgender people’s sexuality, since there’s nothing worse than being thought of as flirting (or worse) with a transgender person, and gives cis judges and juries a reason to excuse anti-transgender hate crimes.
Disclosure is the process of telling a person that you’re transgender, and it’s a very personal decision that comes with inherent safety risks. Every trans person knows there is some risk in telling someone new, ranging from a new possible ally to a barrage of insults to even being hate-crimed. Some people prefer being out because they feel safe to do so, while others remain stealth – but not because they’re hoping to trick someone.
The transgender community advises sexually active folks to have that tough conversation with a prospective partner before you’re in the bedroom. Each person is different: a transgender woman who has had bottom surgery might not need to disclose her transgender status during a one-night stand because there’s nothing actually distinguishing her from other women compared to the safety risk of telling a stranger that you’re trans; a transgender man might feel inclined to tell a women he’s been seeing that he’s trans because aspects of his transness could affect their potential future together.
Cisgender people get frustrated about disclosure: they feel entitled to know whether someone is transgender. Some cis folks believe they “always know” when someone is trans, too. Yes, it is ideal for transgender people to be open about their identities, but cisgender people cannot be entitled to that knowledge as long as we exist in a society that is dangerous to live in. In comparison, there are so many other things you might want to know when having a one-night stand or going on a date with someone, like whether they’re infertile, if they have a stable job, if they have a disability, or already have children. But we all understand we are not entitled to automatically get that knowledge, and it completely upends how humans socially interact with each other via the social script.
On the other end of the spectrum, there is a community of cisgender folks who want to have sex with trans individuals because they fetishize us as a kink. Chasers (or “admirers,” as they call themselves) actively seek us out for sex. Any porn website will have a transgender category. Trans-specific dating apps exist purely for chasers’ convenience. We do not need to “trick” cisgender people into having sex with us. Should transgender people like chasers? That’s another topic for a different post – the ultimate point is no, we don’t trick cisgender people.
Because of the above, there is actually a subsection of the transgender community that identifies as T4T, or “trans for trans.” These trans folks only date other transgender people – but unlike chasers, they do so because they feel safer and better understood by other transgender people. We don’t have to explain our transness or the complications of gender theory to another transgender person to feel heard; we don’t have to fear that they might believe we’re going to hell for being trans or go into a violent rage because of who we are.
Myth #4: Transgender people are sexually aroused by their bodies. / Transgender people hate their bodies.
I combined two common myths for this one because both relate to how cisgender people fail to empathize with trans experiences. The first part, or the belief that all transgender people get turned on by their bodies, relates to Freudian-era pseudoscience and confusing transvestites with transgender people.
There are individuals who are sexually aroused by their bodies: the scientific terms are autogynephilia and autoandrophilia. But unlike transvestites, transgender people do not transition because they seek sexual pleasure. Generally, transvestites just stop at crossdressing (aka not continuing transition by seeking hormones or surgery) because they don’t actually want to identify as another gender. Yet transvestites were infinitely more interesting to research during the early years of sexology, so research papers were written for years with this base assumption that transgender people transition out of kink.
Are transgender people allowed to be sexually aroused by their bodies? Cisgender people are allowed to feel confident or sexy when looking at themselves in the mirror. It would be hypocritical to say transgender people do not deserve that same right. To feel comfortable in our bodies, that includes having the capacity to feel sexual in them, too. But that’s more a philosophical question outside of the realm of this myth.
The second part, or that transgender people must hate their bodies, also dates back to early research on transgender people. Cisgender people have always struggled to grasp what causes a person to want to be a different gender – very few cis people think critically about their relationship with their sex assigned at birth, so gender isn’t something they’ve really considered. To rebel against their natural worldview, they believe transgender people must hate their bodies – anything else wouldn’t make sense.
These assumptions permeated the very beginning of transgender researchers, and even trans-friendly providers held these stereotypes. It became quickly obvious that to transition socially, medically, or legally, transgender people had to adhere to these stereotypes since cisgender people held the power to prescribe medicine or affirm legal changes that transgender folks did not. To allow trans people to transition, doctors wanted them to fit their rigid boxes of what they believed transness to be – and that always included the stereotype that transgender people absolutely hate their biological bodies.
Today, there’s a decent understanding within the scientific community that transgender identity does not come from a hatred of one’s body but rather a disconnect between one’s internal versus outward gender. That disconnect can include feelings of hatred, but it doesn’t have to. The term “gender dysphoria” refers to that disconnect, ranging in feeling just uncomfortable to more extreme disgust or hatred. There is also a community of individuals promoting the idea that gender euphoria is just as important as gender dysphoria when discussing the need for transition – transgender people should not be expected to hate themselves. To be happy and fulfilled people, we need to be allowed to feel content in our bodies.
Myth #5: Transgender people want to dominate in sports, prisons, schools, etc.
We aren’t asking for unlimited access to dominate sports, we want the right to play fairly as ourselves. Until the past year or so, transgender people have been playing small roles within sports without issue: most leagues have written rules on how transgender people may participate, which usually requires two to three years of documented hormone replacement therapy. HRT is the key factor on supposed “advantages,” since hormones dictate muscle growth, strength, and stamina in all human bodies. A transgender woman who has been on prescribed estrogen for five years has no biological advantage over a cisgender woman – and quite frankly, cisgender women do hold an advantage if they compete with naturally high testosterone or a hormone disorder. Other aspects of transition, like surgery or legal status, have zero bearing on competitive performance.
For emphasis, transgender people have been officially allowed to compete in the Olympics since 2004. The exact rules have varied, but the general consensus to be allowed to participate is hormone replacement therapy. And the standards used by the Olympics are used in countless other sports and minor leagues.
Some folks might still get up in arms about other “advantages” transgender may have, but none of them warrant barring a group of people from fair play. A transgender woman who is six foot might have an advantage at basketball, but so does a cisgender woman who is also six foot. It’s those small advantages that drive people to play sports based on what they’re good at. It’s the nature of competition and sports. Getting up in arms about bone structure or child socialization is just as nonsensical as barring people based on race, ethnicity, disability, and even class.
This myth is more ludicrous in school settings. It’s difficult to argue against the benefits of school sports: they provide exercise while giving youth crucial team building skills while they socialize in a structured setting. But due to the stigma transgender people automatically get from participating in sports, very few of us do – and even fewer participate in school sports. Even in the most liberal states, transgender students still have to adhere to established protocols, which almost always relate to documented hormone replacement therapy. Out of the thousands of students that participate in school sports each here, only one or two of them identify as transgender. If they’re playing by the rules, it’s hardly fair to ban them based on identity alone.
Lastly, transgender people don’t go to prison to use taxpayer dollars for gender-affirming care. It’s way easier to transition beyond prison, and the dangers transgender people are exposed to in prison are never worth it: compared to cisgender adults, transgender people are roughly 10 times more likely to be assaulted by both fellow prisoners and prison staff. Most transgender people are forcibly detransitioned while incarcerated, so the reality is closer to transgender people asking if they can access or continue medical care while incarcerated.
Know the basics about hormone replacement therapy but feel like there’s still more to learn? Previously, I wrote about the basics of HRT – the process of taking prescribed synthetic testosterone or estrogen to align one’s physical body and sex characteristics with their gender identity. Despite the GOP’s war on transgender people, HRT has been firmly backed by medical science for nearly a century as the best treatment to prescribe. No amount of conversion therapy or repression is as effective nor humane as accessible trans-affirming care – and ‘trans regret‘ and ‘social contagion‘ theories have been repeatedly debunked by scientific research.
DISCLAIMER: This post is for informational purposes only and does not provide professional advice. Always seek the advice of a qualified healthcare provider with questions regarding medical conditions or treatments.
What’s the difference between HRT 1.0 and HRT 2.0?
My previous post explained the basics of hormone replacement therapy, puberty blockers, common myths, and recommended routes to accessing legal HRT via informed consent and written letters.
In today’s political climate, it may not be possible to access HRT through traditional legal routes. In contrast to my previous post, HRT 2.0 provides an overview of alternative routes – but remember the above disclaimer and be mindful of the legal risks involved. When possible, always get HRT prescribed through traditional legal routes. Don’t take risks when they aren’t necessary. For American adults, we are currently still at a point where it is feasible – and safer – to obtain HRT through mainstream doctors. Even when there are no local doctors physically available, telehealth now offers transgender folks the ability to get legal prescriptions online.
“DIY HRT” is the practice of obtaining and administering hormone replacement therapy without a licensed medical provider or prescription. Today, it’s fairly rare within the United States as long as individuals have physical and financial access to a provider, but it was the most common method for transgender folks decades ago when most healthcare professionals were unwilling to prescribe HRT. Beyond the US, DIY is still a common practice in countries where transgender identity is strictly regulated or criminalized.
By nature, DIY HRT communities are difficult to find on the mainstream internet, but they aren’t impossible to find. In addition to the medical disclaimer, DIY HRT communities are not open to minors. You might be able to find basic information, but these communities are already on high alert due to their potentially illegal nature and therefore generally unwilling to have open discussions with individuals under the age of 18. DIY HRT and its legality vary drastically by country – even within the United States, synthetic estrogen and testosterone have different laws applied to them. Throughout most of the world, possession of HRT isn’t a criminal offense, unlike the trade of unprescribed medication. To circumvent this, this article uses the same logic as most DIY communities on the clear web – this article is for purely informational purposes, and I do not endorse DIY HRT. As mentioned above, I actually advise getting your hormones from a licensed provider when possible.
Is DIY HRT Dangerous?
Anecdotally, it’s generally safe. All medicines and procedures carry some inherent risk, and hormone replacement therapy is no different. Traditional HRT carries no substantial medical risk compared to cisgender people, although there are (often discredited) doctors who will attribute unrelated issues to being on HRT.
DIY HRT isn’t much different as long as you know the potential risks and benefits of basic hormone therapy. The largest health risks associated with DIY are reduced by monitoring and appropriately adjusting your hormone levels through regular blood work – a process you’d normally do with a licensed provider, too. Blood tests are not negotiable; most external signs cannot feasibly identify whether you’re on a safe or unsafe dose. Monitoring your levels protects your long-term health.
Where do I learn more about DIY HRT?
For clear web users, there are two sources: r/TransDIY and The DIY HRT Directory. The Directory provides details on medication levels, distributors, and blood work, whereas r/TransDIY offers an open forum for discussions and questions in addition to general guides. The Directory currently does not offer any contact feature, so you should visit r/TransDIY for support.
The most common form of synthetic testosterone is injection-based, usually as testosterone propionate, testosterone cypionate, or testosterone enanthate. Both cypionate and enanthate have long half-lives (which determines the length of time the testosterone will last in your body). Gels are rare, but occasionally possible to find – although it is difficult to source the amount of gel needed for appropriate hormone levels.
For all forms of HRT, you begin on a much lower dose initially and progress to a stable regular dosage based on your blood work. Most medical providers mimic the natural hormone cycle of cisgender men, putting individuals on a low dose before increasing over the first few years, and then slightly lowering to a long-term level.
DOSAGE
Low Dose
Initial Dose
Typical Maximum
Testosterone Cypionate
20 mg per week IM/SQ
50 mg per week IM/SQ
100 mg per week IM/SQ
Testosterone Enanthate
20 mg per week IM/SQ
50 mg per week IM/SQ
100 mg per week IM/SQ
For more info on dosages, mainstream providers have guides available online for informed consent purposes.
Do NOT try to achieve a higher dose than what is needed. In addition to long-term health risks, high hormone doses are subject to the possible ‘spillover effect’ (clinically known as aromatization), where excess HRT will convert to your naturally produced sex hormone (aka estrogen).
Vials of injectable testosterone are often compounded as 200 mg/mL, 250 mg/mL, or 300 mg/mL. In common language, in a 200 mg/mL vial, there is 200 mg of testosterone in each milliliter. If the vial contains 10 milliliters of liquid testosterone, there are 2,000 milligrams of total testosterone in that vial.
Due to this, you will have to do math to calculate exactly how much liquid to inject to achieve your target dosage. Medical providers would calculate this for you, but you’ll have to do so when calculating for DIY. The formula used is:(amount you want to inject) ÷ (concentration of the vial) = amount to inject per dose in mL.
EXAMPLE: John has acquired a 200 mg/mL vial of testosterone and wants to have a 50 mg per week dose. (50) ÷ (200) = 0.25 Based on the above formula, John should inject 0.25 mL per injection.
Since injectable testosterone is fairly thick, it requires a thicker needle for proper injection. For intramuscular injections, it is recommended to use needles between 1″ to 1.5″ in length and 23-25g gauge (needle thickness). Subcutaneous injections should use needles between 1/2″ to 5/8″ in length and 25-30g gauge.
Compared to transmasculine DIY, which usually only requires injecting and monitoring testosterone levels, effective transfeminine HRT requires both synthetic estrogen and testosterone blockers.
Additionally, estrogen can be ‘homebrewed’ rather than purchased through a pharmaceutical company unlike testosterone (which cannot be produced at home). Within the DIY community, estrogen is commonly ‘homebrewed.’ Homebrewed estrogen is produced by individuals through raw estradiol ester/bicalutamide/etc powder. Pharmaceutical-grade estrogen is produced by legitimate pharmaceutical companies – these forms of estrogen are widely considered safer, but they are more expensive than homebrewed sources.
The most common form of estrogen is pill-based – they’re the most prescribed by licensed doctors and also the easiest to DIY. Synthetic estrogen does not harm the body the same way testosterone does in pill form, which is why transmasculine folks opt for injection routes. Always use bioidentical estrogens such as estradiol hemihydrate or estradiol valerate. Never use non-bioidentical estrogens for HRT. Estrogen can also be taken as a gel, patch, or injection – pills are cheapest per month, while injections are cheaper annually or long-term.
The most common testosterone blockers (antiandrogens) are pills that must be swallowed, which include spironolactone, cyproterone acetate, and bicalutamide. Spiro is the most famous, but is considered a weak (but much safer) antiandrogen. Cypro and bica are considered strongly effective but must be used with caution due to harsher health risks.
DOSAGE
The following guidance is considered a higher-than-average regimen than what most individuals may use. Adjust accordingly based on blood testing.
REGIME 1
Cyproterone acetate | 6.25-12.5 mg per day
Estradiol | 3 mg twice per day
REGIME 2
Bicalutamide | 50 mg per day
Estradiol | 3 mg twice per day
For DIY cypro, you will need a pill cutter to create the above dosage. If your testosterone levels are not adequately suppressed, increase your estrogen dosage.
Bica may cause blood testosterone levels to INCREASE slightly, so make sure your T is adequately blocked. 50mg is advised as generally adequate for testosterone suppression when combined with estradiol.
For more info on dosages, mainstream providers have guides available online for informed consent purposes.
Do NOT try to achieve a higher dose than what is needed. In addition to long-term health risks, high hormone doses are subject to the possible ‘spillover effect’ (clinically known as aromatization), where excess HRT will convert to your naturally produced sex hormone (aka testosterone).
Sourcing & Supplies
How do you find DIY HRT? Considering its legal status, it can be difficult to find – the following information and links are from major sources like r/TransDIY and the Directory. The Directory has not been updated in a few years, but r/TransDIY continues to be moderated – check its information for the most current verified distributors.
Injection Supplies
It’s fairly easy to get syringes and injection equipment – you don’t need a prescription to access them. Most countries allow you to purchase needles from any pharmacy, although you may need to speak directly with a pharmacist. Online, Amazon is the most popular source for American DIY users.
Amazon states needles are ‘not suitable’ for human use – but this is untrue and put to skirt around American Amazon regulations that prohibit the sale of medical supplies.
Medications
Listed below are the most common and reputable pharmaceutical distributors for DIY HRT. Use extreme caution if using a source that is not listed below or on either r/TransDIY or the Directory. Most in the DIY community purchase legitimate pharmaceutical-grade medication from foreign companies that permit the sale of these drugs internationally. To use these companies, you will have to learn how to buy cryptocurrency like Bitcoin or utilize an international system like Zelle or MoneyGram.
When purchasing HRT internationally, it is best practice to buy small amounts in case it is confiscated by customs. Individuals are rarely prosecuted or arrested for attempting to order international HRT, but your shipment can be seized. By ordering in small amounts, you reduce the amount lost when seized. Domestic purchases are not screened like international shipments, so there is little to no risk of losing your order.
Another route for DIY-ish HRT is stockpiling, which works well alongside informed consent and other methods of obtaining legal HRT. Since hormones are prescribed at an exact dose by providers, there are two ways to stockpile HRT from stockpile-adverse providers (although there is a growing number of providers that understand the volatile political climate transgender Americans are facing and why folks want to stockpile). Both methods described below are slow processes – you’re not going to be able to stockpile overnight through your provider.
By purposely taking less than your prescription in the days leading up to blood testing by your provider, your hormone levels will show up as low. In response, most providers will prescribe an increased dose to stabilize your levels. Once prescribed, individuals return to their former dosage regime and save the excess for future use.
Some individuals purposely take a lower dose regularly than their prescription to save the excess for stockpiling. This method is used when an increased prescription cannot be received but will result in slower transition, similar to the effects of low-dose HRT.
If possible, do not travel with DIY HRT – especially testosterone. Testosterone is strictly regulated compared to estrogen, and unprescribed medication can be charged as possession of a controlled substance if found by airport security. If you MUST travel, clearly label your testosterone in a large clear Ziploc bag and throw in over-the-counter medication like aspirin and allergy meds alongside in the bag. Airport security will be less likely to hound you for a prescription. If you are arrested, do not say anything to the police and contact a lawyer as soon as the opportunity is presented.
Blood Testing
Especially when beginning HRT, blood testing is recommended every three months – although every six months becomes more common later on. For DIY, you should get a blood test after one month on HRT and then every three months. It is advised to find a healthcare facility local to your location for blood testing, although you may have to ask to manually see your results. For accurate results and monitoring purposes, ALWAYS get your estradiol (E2) and total testosterone (T) tested every time. Additional information from blood tests are useful for monitoring potential side effects of HRT, but not as mandatory.
Transfeminine
Testosterone levels should range at 50 ng/dL or lower and estradiol should range at 100 pg/mL or above.
Transmasculine
Testosterone levels should range between 300-1,000 ng/dL and estradiol should range between 10-50 pg/mL. Unlike transfeminine HRT, testosterone hormone therapy naturally lowers naturally produced estrogen more easily.
As many readers know, HIV also disproportionately affects LGBTQIA+ people – it was once referred to as the “gay plague” during its early years when thousands of queer people were being killed each year while government-funded research facilities pushed the harmful belief that HIV was a divine punishment ordained by God. All marginalized groups are at higher risk of contracting HIV, culminating from a lack of educated doctors, accessible testing, preventative medicine like PrEP and PEP, and public knowledge. Ultimately, this means that young queer people are at an exceptionally higher risk of HIV – especially transgender youth of color.
Despite heightened rates reported by the CDC, they also found that only 6% of high school students had ever been tested for HIV. Most people are never offered an HIV test when visiting a healthcare provider’s office – there’s often very little signage and educational material present advertising HIV prevention and its risk and even fewer offices discuss HIV with their patients unless they believe they’re a ‘high risk.’ Unfortunately, this process is based on stereotypes even among healthcare providers well-educated on HIV versus reality – so lots of folks fall through the cracks. The CDC recommends all individuals, regardless of sexual orientation, gender identity, age, class, race, ethnicity, or background, be tested for HIV at least once in their life. Certain people are advised to be tested regularly based on their sexual activity – as a general note, the CDC says the following people should be tested for HIV at least once per year:
Men who have had sex with other men.*
Individuals who have had anal or vaginal sex with someone who is living with HIV.
Individuals who have had sex with more than one partner since their last HIV test.
Drug users who share injection equipment, like needles, syringes, and cookers.
Individuals who have had sex for money, drugs, or housing.
Individuals who have been diagnosed with another STD/STI, hepatitis, or tuberculosis.
Anyone who has had sex with someone who has done one of the above things or you’re unsure about their sexual history.
In February 2025, the Trump administration tried to remove mentions of LGBTQIA+ people from official government websites – including the CDC. Federal courts have rebuked this decision as purposeful misinformation of scientific research and forced the administration to restore previous web pages, although they have altered some of the sites and added a political anti-science disclaimer stating the agency denounces transgender people alongside the Trump administration.
All governmental information and research regarding HIV was targeted by this purge – I’m unsure whether the first statement was present before the restoration since it’s not aligned with current HIV advocacy and data. Most organizations disagree with blanket stereotypes for HIV and testing based on sexuality, instead pushing for non-discriminatory testing requirements based on sexual activity. This can be seen in the change in the Red Cross’s policies allowing queer men to finally donate blood after decades of permanently banning them for “having had sex with men” since data shows such practices do not effectively reduce HIV risk during blood donation.
HIV 101: The Basics
In today’s world, most people have a basic understanding that HIV exists, that it’s an STD, and it disproportionately targets queer men. Other than that, knowledge varies drastically since HIV isn’t covered in many public school sexual education programs (and several states don’t have sex ed) and most healthcare providers do not bring up HIV unless they believe they have enough reason to do so.
As mentioned earlier, anyone can be affected by HIV – the virus doesn’t discriminate based on sexual orientation, gender identity, race, ethnicity, age, class, education, religion, neighborhood, etc. There is no singular way to ‘tell’ if someone has HIV other than getting tested: most people don’t experience symptoms until HIV has developed into AIDS years later. Lastly, HIV won’t kill you – while living with HIV will greatly change your life, people live long, happy, and fulfilling lives with HIV when taking prescribed medication to treat the virus.
Want to learn more about HIV?Read this post here or check out one of the sources below.
Education is crucial.Teaching youth about HIV and safe sex is the first step in reducing the spread of STDs, including HIV. Despite this reality, many schools, politicians, and religious figures argue that comprehensive sex education encourages young people to have sex. This is fallacious – data shows that folks will have sex regardless, but it is possible to reduce STDs and unplanned pregnancies by giving them the tools to have safe and healthy relationships.
Accessibility is just as important. Most people know what they ought to do, whether it’s safe sex or recycling plastic. However, they’re unlikely to do it unless it is convenient – it’s human nature. Convenient testing is offered at regular healthcare visits, community centers, and even social events like local drag shows and pride events. Some organizations offer incentives for testing like free entry to an event, gift cards, vouchers, or coupons to engage folks in testing when they may otherwise be too hesitant. Making condoms free and easy to access discreetly without shame encourages people to practice safe sex. Preventative medicines like PrEP and PEP are most impactful when folks have access to those medicines when they need them – whether it’s by visiting a local pharmacy or getting it mailed directly to their house.
Where do I get tested for HIV?
You can only get treatment for HIV if you’ve tested positive, which requires you to get tested in the first place – so seeking testing is the first step to protecting your health. The earlier someone gets diagnosed, the sooner they can access life-saving treatments to manage their HIV.
Greater Than (linked above) is one of the largest public health campaigns in the United States that provides detailed resources in partnership with the CDC. Click above to be redirected to their website, which locates HIV testing, PrEP providers, and support services locally by zip code. Greater Than also connects individuals to health insurance information to educate users on state laws dictating coverage.
IRL testing isn’t for everyone – that’s why the CDC also sponsors the Together TakeMeHome program to ship free HIV tests directly to homes throughout the United States. These tests are done via an oral swab with saliva to give results within 20 minutes, and the program provides two free tests to individuals every 90 days. Together TakeMeHome has been providing free tests since early 2023, so click the button below to learn more about how to use their services.
Together TakeMeHome is currently operating, although it can only do so through government funding. Due to the current political climate and attacks by the Trump administration on other HIV programs, it’s not impossible to consider the possibility that the program could be shut down in the future. Most LGBTQIA+ community centers also provide HIV testing for free, and many cities offer similar programs to Together TakeMeHome with mail programs to increase HIV testing in their area.
Know Your Rights: Young People, HIV, and the Law
In the United States, all individuals with HIV are protected by the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, which is enforced by the Department of Health and Human Services and the Office for Civil Rights. These laws prohibit any anti-HIV discrimination by healthcare and human services agencies that receive federal funding, as well as any discrimination by state or local governments – including services, activities, or programs provided by state or local governments. Anyone can file a report with the Office for Civil Rights online or by mail.
In all US states, minors have the right to consent to HIV and STD testing and treatment without a guardian’s permission. Generally, youth have the right to get tested (and receive HIV medication) without telling their parents. However, these laws vary on whether you have the right to access preventative services like PrEP without parental consent. There are no state or federal laws that explicitly prohibit minors from accessing PrEP, but you should search for laws specific to your state for details.
Many states don’t have health confidentiality protections for minors, so it’s extremely likely for your guardian to find your status if you get tested at your primary provider – especially if your doctor bills your family’s insurance company for the test. For this reason, many LGBTQIA+ community centers provide free confidential HIV testing to encourage youth to get tested without fear that their authority figures will discover they got tested.
While many US states and territories require you to disclose your HIV status, you’re only required to disclose it to certain people. At the time of this article, thirteen states require you to disclose your status to potential sexual partners, while four require disclosure to anyone you share a needle with.
Depending on the state, failure to disclose status can lead to life in prison. You do not have to disclose to anyone else – including your family or friends. While most American employers have the right to ask about your health in certain fields, you don’t have to disclose it to your workplace in most cases. The Americans with Disabilities Act protects you from anti-HIV discrimination – which means hiring managers can’t ask you about your health and companies have to make reasonable adjustments as needed. These protections also apply within education, so you’re not required to disclose your HIV status to anyone at school unless you reside in a state requiring disclosure for potential sexual partners or needle sharing.
AIDS Drug Assistance Program@ adap.directory / Patient-centric project that provides HIV-related services and prescription medication to hundreds of thousands of people in the United States by linking individuals with their local state or territory agency.
AIDS Healthcare Foundation @ aidshealth.org / 323-860-5200 / International nonprofit based in Los Angeles that operates a network of HIV services in over 40 countries across Latin America, Africa, Asia, and Europe.
Asian Pacific AIDS Intervention Team @ apaitssg.org/ Grassroots AIDS service organization centered on Asian and Pacific Islanders with HIV, based in the United States.
Bienestar Human Services @ bienestar.org / US community-based social services organization that caters to Latino Americans living with HIV, especially LGBTQIA+ Latino Americans.
Black AIDS Institute @ blackaids.org / Think tank that aims to end the HIV/AIDS epidemic in the Black American community through awareness messaging, information, and robust programs.
CDC-INFO @ cdc.gov / 800-232-4626 / Live support to help Americans find the latest and reliable science-based health information, including CDC guidance and resources.
Global Network of People Living with HIV @ gnpplus.net / Network operated by people living with HIV for people living with HIV, regardless of geographic location.
HIV/AIDS/Hepatitis C Nightline / 800-273-2437 / US hotline providing support for people living with HIV or Hepatitis C as well as their caregivers.
HIV. GOV @ hiv.gov / Offers information about HIV/AIDS prevention, treatment, and resources for anyone in the United States.
HIV.GOV Service Locator @ locator.hiv.gov / Location-based search tool managed by the United States Department of Health and Human Services to allow anyone to find local HIV testing services, housing providers, health centers, PrEP, PEP, and other related needs.
HIV Management Warmline / 800-933-3413 / Non-emergency telephone service for questions about HIV, antiretroviral therapy, HIV clinical trials, and laboratory evaluation in the United States.
International AIDS Society @ iasociety.org / Research-based organization that develops holistic approaches to HIV/AIDS treatment and prevention.
International Planned Parenthood Federation @ ippf.org / 202-987-9364 / Global healthcare provider that has been a leader in sexual and reproductive health for all since 1952.
Latino Commission on AIDS @ latinoaids.org / Nonprofit organization in response to the critical unmet need for HIV prevention, treatment, and education in the Latino community in the United States.
LGBT National Help Center @ lgbthotline.org / 888-843-4564 /Free and confidential peer support, information, and local resources where volunteers help connect you to other groups and services in the US. Also maintains a coming out hotline, youth talkline, and senior hotline.
National AIDS Hotline / 800-243-2437 / Federal hotline to refer the general American public to relevant state and local resources.
National AIDS Treatment Advocacy Project @ natap.org / 212-219-0106 / Nonprofit corporation in the United States that educates individuals on HIV treatments on the local, national, and international levels.
National Clinician Consultation Center @ nccc.ucsf.edu / 833-622-2463 / Teleconsultation resource that educates US healthcare providers with information and answers on HIV and Hepatitis C.
National Minority AIDS Council @ nmac.org / Advocacy nonprofit that provides training and resources catered to marginalized communities in the United States.
National Native HIV Network @ nnhn.org / Indigenous-led network that mobilizes American Indians, Indigenous Americans, Alaska Natives, and Native Hawaiians towards community action.
NIH Office of AIDS Research @ hivinfo.nih.gov / 800-448-0440 / Confidential answers to questions on HIV/AIDS clinical trials and treatment in the United States.
PEPline / 888-448-4911 / Hotline for individuals interested in information about PEP, especially those who have been possibly exposed to HIV while on the job in the United States.
Perinatal HIV Hotline / 888-448-8765 / Resource hotline available 24/7 in the United States for pregnant people living with HIV to find answers and tools.
Positively Trans @ transgenderlawcenter.org / Program through the Transgender Law Center to support transgender people living with HIV in the United States.
Positive Women’s Network @ pwn-usa.org / Advocacy and resource organization for women living with HIV.
PrEPline / 855-448-7737 / Hotline about how to start, continue, or manage use of PrEP for HIV within the US.
Ryan White HIV/AIDS Program @ ryanwhite.hrsa.gov / National services and resources for low-income individuals living with HIV in the US.
TheBody.com Hotline @ thebody.com / News site based in New York that centers on publishing HIV-related information.
The Trevor Project @ thetrevorproject.org / 866-488-7386 / The leading suicide prevention and crisis intervention organization centered on LGBTQIA+ young people in the United States. Offers 24/7/365 information and support to those ages 13 to 24 with trained counselors via call, text, or instant message.
The Well Project @ thewellproject.org / United States nonprofit that primarily supports women and girls living with HIV/AIDS.
Trans Lifeline @ translifeline.org / 877-565-8860 / Transgender-centered crisis organization that does not use involuntary intervention/forced hospitalization to provide support to transgender people through fully anonymous and confidential calls within the United States and Canada.
UNAIDS @ unaids.org/ 41-22-595-59-92 / International agency that seeks to end AIDS as a public health threat by 2030 and has operated since 1996 to assist the United Nations in combating HIV and AIDS.
Surgery can be an important step in the journeys of many transgender people in their pursuit to live comfortably and authentically as themselves. The ability to get necessary medical care is integral for democracy, and the ability for transgender folks to choose when, how, and why they get gender affirmation surgery is important for bodily autonomy. Learn about the basics of related surgeries in this post. Looking for information about HRT or general transgender resources?
DISCLAIMER: It is still common for people to believe transgender people must get “the surgery” or at least be actively pursuing it. There are even people who believe you must get “the surgery” before identifying as transgender – while “the surgery” usually refers to bottom surgery, also known as genital surgery or sex reassignment surgery, these notions are both false. Surgery is a personal choice, and there are many reasons why a transgender person may want or not want a procedure – it doesn’t make them less transgender.
Glossary
The following are frequently used terms that will help guide your understanding of this article. It isn’t comprehensive, but it’s a great starting point.
GENDER AFFIRMATION SURGERY
The most modern term for any surgery done to affirm the gender of a transgender person – which includes all of the surgeries in this article. There is no single surgery all transgender people seek to get, which is why “gender affirmation surgery,” or GAS, fits in today’s language. Other terms include gender confirmation surgery, gender reassignment surgery, and sex reassignment surgery – while they have different connotations, they generally mean the same thing.
The only term not advised to use is “sex change.” This term is usually considered offensive due to its negative connotation and usage.
PRE-OP/POST-OP/NON-OP
These terms are all short-hand and slang used within the transgender community to describe surgery status.
Pre-op, or pre-operative, refers to a transgender person who seeks a gender affirmation surgery of some sort but has not received it due to a variety of reasons, like medical barriers, cost, physical health, safety, etc.
Post-op, or post-operative, refers to a transgender person who sought a gender affirmation surgery and has received it.
Non-op, or non-operative, refers to a transgender person who does not seek a certain gender affirmation surgery and does not plan to pursue it out of personal choice, rather than the barriers mentioned for pre-op individuals.
It is possible to be pre-op, post-op, and non-op at the same time – these terms are usually used within the community for specific surgeries as well as surgical status as a whole. Someone can consider post-op for having a chest reconstruction surgery, pre-op for seeking bottom surgery like metoidioplasty, and non-op for not wanting to pursue a procedure like facial surgery.
MEDICALLY NECESSARY
This term is often used within healthcare and insurance to describe whether a treatment will be covered by your insurance provider. Medically necessary treatments are services that are deemed as important for diagnosing, treating, or preventing an illness or injury. To qualify as medically necessary, treatment must be regarded as effective for your condition and must be done per generally accepted medical practices.
At the end of the day, transgender healthcare is considered medically necessary because it’s supported by all major medical institutions and is backed by decades of research proving the positive impact of trans-related treatments. Not all treatment options are considered medically necessary, though, and this article will point out which are and which are not.
Requirements for Gender-Affirming Surgery
Any surgeon who performs gender affirmation surgeries should follow the standards of care guidelines by the World Professional Association for Transgender Health (WPATH), which has produced these standards based on best healthcare practices since its founding in 1979. For historical context, WPATH was originally known as the Harry Benjamin International Gender Dysphoria Association – named after Harry Benjamin, who worked with Magnus Hirschfeld to provide healthcare to transgender and queer folks in pre-Nazi Germany.
WPATH has recently gotten negative media attention, sparked by the executive order by President Donald Trump “Protecting Children from Chemical and Surgical Mutilation.”The order, fueled by Project 2025, falsely accuses WPATH of being “junk science” despite decades of peer-reviewed research and being internationally agreed as the best treatment standard for gender dysphoria. Ordering all government agencies to rescind any policies that use WPATH, Trump and Project 2025 use actual junk science to fuel their anti-transgender claims.
The 8th edition of the Standards of Care was released in 2022, and research and guidelines on surgery are detailed in Chapter 13.
“In appropriately selected TGD individuals, the current literature supports the benefits of GAS. While complications following GAS occur, many are either minor or can be treated with local care on an outpatient basis. In addition, complication rates are consistent with those of similar procedures performed for different diagnoses (i.e., non-gender-affirming procedures)… The efficacy of top surgery has been demonstrated in multiple domains, including a consistent and direct increase in health-related quality of life, a significant decrease in gender dysphoria, and a consistent increase in satisfaction with body and appearance. Additionally, rates of regret remain very low, varying from 0 to 4%… Although different assessment measurements were used, the results from all studies consistently reported both a high level of patient satisfaction (78–100%) as well as satisfaction with sexual function (75–100%). This was especially evident when using more recent surgical techniques. Gender-affirming vaginoplasty was also associated with a low rate of complications and a low incidence of regret (0–8%).”
“If written documentation or a letter is required to recommend gender affirming medical and surgical treatment (GAMST), only one letter of assessment from a health care professional who has competencies in the assessment of transgender and gender diverse people is needed…
Criteria for Surgery: a. Gender incongruence is marked and sustained; b. Meets diagnostic criteria for gender incongruence prior to gender-affirming surgical intervention in regions where a diagnosis is necessary to access health care; c. Demonstrates capacity to consent for the specific gender-affirming surgical intervention; d. Understands the effect of gender-affirming surgical intervention on reproduction and they have explored reproductive options; e. Other possible causes of apparent gender incongruence have been identified and excluded; f. Mental health and physical conditions that could negatively impact the outcome of gender-affirming surgical intervention have been assessed, with risks and benefits have been discussed; g. Stable on their gender affirming hormonal treatment regime (which may include at least 6 months of hormone treatment or a longer period if required to achieve the desired surgical result, unless hormone therapy is either not desired or is medically contraindicated).”
There are two main takeaways from WPATH’s standards on surgery: the main qualifier to be eligible for gender affirmation surgery and have it be considered medically necessary is identifying with having gender dysphoria for a substantial length of time – usually between six to twelve months; most additional requirements like letters and use of hormone replacement therapy are optional.
Just like I explained regarding HRT, you are not going to find a licensed provider that would be willing to operate on someone who just suddenly ‘decided’ they are transgender – they must firmly believe that you understand the gravity of gender-affirming surgery, that you can fully consent to the procedure, and you are aware of its potential benefits and risks. Any media outlet or online personality that states otherwise is purposely lying to garner attention. While letters are not necessarily required according to WPATH guidelines, written documentation from a healthcare professional or mental health provider establishes the first requirement under WPATH – it gives proof to both your prospective surgeon and insurance company that you have experienced gender dysphoria for a set amount of time.
A decade ago, it was common for surgeons to require additional hoops for transgender people to access gender-affirmation surgery. Most often, surgeons required their prospective patients to have written documentation proving they had been on hormone replacement therapy for up to three years before they would consider them eligible for surgery. These HRT requirements weren’t usually pushed by insurance providers but existed as an additional safeguard for surgeons to lengthen the process of care – but it also served as a method of gatekeeping. Hormone replacement therapy is still a requirement for select surgeries where the effects of HRT have a direct positive impact on the result of a surgery, like testosterone and metoidioplasty. Other surgeries, like vaginoplasty or phalloplasty, may require electrolysis or laser hair removal. Going back further in time, surgeons also commonly required patients to have “real-life experience,” or proof that they were living as their chosen gender “full-time” – these requirements disproportionally barred individuals who were unable to transition out of safety, which is why they fell out of favor, although today’s societal acceptance of transgender people means more folks can live as themselves before surgery.
These requirements are not the same as those placed on transgender minors – WPATH has different guidelines for youth procedures:
“Criteria for Surgery: – A comprehensive biopsychosocial assessment including relevant mental health and medical professionals; – Involvement of parent(s)/guardian(s) in the assessment process, unless their involvement is determined to be harmful to the adolescent or not feasible; – If written documentation or a letter is required to recommend gender-affirming medical and surgical treatment (GAMST), only one letter of assessment from a member of the multidisciplinary team is needed. This letter needs to reflect the assessment and opinion from the team that involves both medical and mental health professionals (MHPs).
a. Gender diversity/incongruence is marked and sustained over time; b. Meets the diagnostic criteria of gender incongruence in situations where a diagnosis is necessary to access health care; c. Demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment; d. Mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed; sufficiently so that gender-affirming medical treatment can be provided optimally. e. Informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility; f. At least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result for gender-affirming procedures, including breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment unless hormone therapy is either not desired or is medically contraindicated.” – Standards of Care Version 8, WPATH summary requirements for youth surgery.
Some of the requirements are the same – but there are important distinctions. WPATH has a longer length for HRT usage than adults, and their standards also dictate the requirements for HRT and puberty blockers in transgender youth. They must have reached Tanner stage 2 of puberty to be eligible for either treatment and have their parents or legal guardians involved in the process. Written documentation has a higher bar set on who can write it for it to be valid for surgery. Youth must also demonstrate emotional and cognitive maturity in addition to proving they fully understand their treatment options. Combined, these standards make surgery incredibly difficult for transgender youth to pursue and push them to wait until after they turn 18, and the requirements lessen. These requirements also firmly debunk false accusations by anti-transgender individuals who claim minors are getting these surgeries en masse – the only surgery trans youth tend to have access to is top surgery or chest reconstruction, which still has all of the above requirements associated with it.
Financing Gender-Affirming Surgery
Surgery is expensive – especially in the United States, which makes money one of the primary barriers in whether transgender folks can pursue gender affirmation surgery. The first step towards financing your surgery is to deep-dive into your insurance coverage. Federal law prohibits most commercial and government insurance programs from discriminating against transgender-related care – but it still happens.
Before continuing, here are some main legal points to keep in mind:
Insurance providers cannot place blanket exclusions. Any plan that states something akin to “all care related to gender transition is excluded” violates federal law.
Insurance providers cannot place categorical exclusions on specific transition-related treatments deemed medically necessary. Plans that purposely exclude coverage for procedures like facial feminization surgery or voice surgery would violate this part of the law.
Insurance providers cannot place discriminatory limits on transition-related care. Any treatment covered for cisgender people must be covered for transgender people, too. For example, plans that cover breast reconstruction for cancer treatment in cisgender women cannot deny transgender people also seeking chest reconstruction for their gender dysphoria.
Insurance providers cannot cancel your coverage, refuse to enroll you, or charge you higher rates because of your transgender status.
Insurance providers cannot deny coverage because it is typically associated with one gender. If a healthcare professional recommends a procedure that is traditionally gendered, like prostate exams or pap smears, insurance providers cannot deny coverage simply because that individual is listed as the “wrong gender” on their paperwork.
If you believe you are experiencing discrimination, there are several steps you can take. Firstly, appeal any insurance denials you receive and keep in mind that you should apply for preauthorization before undergoing any procedures to ensure you know your standing regarding coverage. If your appeals do not go through, you may need to talk to an attorney or legal professional – like the National Center for Lesbian Rights, Lambda Legal, the Transgender Law Center, ACLU, or local organizations. You can also report anti-transgender discrimination with the United States Department of Health and Human Services and state agencies – check out Advocates for Trans Equality’s page for more information.
Confused by the American healthcare system and don’t know where to start with insurance? Click here.
Public Health Providers
Medicaid is the largest public insurance provider in the United States, run as a joint federal and state program to provide free medical coverage to low-income Americans based on income. Each state and territory has its own requirements for Medicaid, so you have to look into the specific policies relevant to where you live. In the majority of the country, transgender-related care is covered by Medicaid for adults – either explicitly by state protections or implicitly by the above protections in federal law. However, Trump’s executive order “Protecting Children from Chemical and Surgical Mutilation” currently bans any transgender-related coverage to minors through government programs like Medicaid, Medicare, and TRICARE. This order is being sued in court, but it has not yet been paused by federal courts – until then, the order causes immense harm as it shuts down gender-related care at major hospitals.
At the time of this article, 10 states ban transgender-related coverage in their Medicaid programs: Idaho, Arizona, Texas, Nebraska, Missouri, Kentucky, Tennessee, Florida, Ohio, and South Carolina. However, as mentioned in this post, it’s worth remembering that not all adults are eligible for Medicaid since 10 states also ban single adults from applying entirely, regardless of income.
Medicare is a federal program that provides medical coverage to people with disabilities as well as older adults ages 65 and older, regardless of income status. Since it is run federally and not controlled by individual states, Medicare offers less flexibility than programs like Medicaid but is less discriminatory as a whole. Since 2014, Medicare has covered transition-related surgery, and there is no national exclusion for transgender treatments. In practice, Medicare deals with trans-related healthcare the same as it does other forms of coverage – each individual is covered on a case-by-case basis based on whether the care is deemed clinically necessary. Learn more here.
The US Department of Veterans Affairs provides free healthcare to anyone who has served in the armed forces and did not receive a dishonorable discharge, while active service members are covered by TRICARE until their service is complete. The VA will cover most transgender-related procedures, including hormone replacement therapy, binders, prosthetics, mental health care, and voice coaching – but the VA still prohibits any coverage of transition-related surgery regardless of medical need.Read more about VA coverage here.
Due to Trump’s executive order “Prioritizing Military Excellence and Readiness,” transgender people are again banned from serving in the United States armed forces. It is unclear whether this ban will dishonorably discharge American servicemembers, similar to the previous Trump ban, but a similar act would bar transgender people from using VA health services despite their service. Since transgender individuals are banned from the military, TRICARE does not offer transition-related services to its active members – although it still currently provides limited treatment coverage to family members of active members as long as they are at least 19 years old.
All Native Americans recognized by a Federally recognized tribe are eligible for free healthcare coverage through Indian Health Services within their official IHS district or reservation. While IHS provides gender-affirming coverage for treatments within their scope, there is no information about their procedures due to the Trump directive to purge government health websites of data – including transgender issues and other unrelated topics. While the federal courts have ordered the administration to restore the data, this story is still developing.
Incarcerated individuals are one of the few groups in the United States entitled to healthcare protected as a constitutional right – although there are no standards of what minimum healthcare must be provided for free since it is not codified or elaborated in law. Gender-affirming care, including hormone replacement therapy and surgery, are supposedly protected rights – but most prisons have barriers in place, like requiring proof of care before arrest. These barriers are what cause a quarter of transgender inmates to be denied healthcare, even though accrediting organizations like the National Commission on Correctional Health Care recommend transgender procedures.
Commercial Providers
The majority of Americans use commercial insurance through the Healthcare Insurance Marketplace or their employer when they do not meet the criteria for other providers like Medicaid, CHIP, Medicare, IHS, VA, TRICARE, etc. Anyone at least 18 years old and not currently incarcerated is eligible for the Marketplace as long as they are lawfully living in the United States and are not eligible for Medicare – individuals eligible for Medicaid are recommended to use the Marketplace since it also issues coverage for those meeting their state guidelines. Out2Enroll is the best national resource for researching care guidelines – their information is entirely free and user-friendly, and their Trans Health Insurance Guides page has up-to-date data for transgender coverage in each state.
Historically, these laws focus on whether commercial providers are allowed to deny transgender-related care. Zero laws intend to outlaw transitional treatments entirely and prevent providers from opting to cover them – in Arkansas, there are still insurance companies that cover transgender treatments even if they’re ‘allowed’ to deny coverage. While there are entities that seek to outlaw transgender care entirely (ex. Project 2025 and the Heritage Foundation), it’s exceedingly unlikely to take that jump – and if it did, the crisis in the United States would cause an international precedent of allowing transgender Americans to flee as refugees due to the depth of that jump. Instead, it is more likely that anti-transgender organizations and people in power will tear away at American healthcare protections in attempts to federally legalize coverage discrimination rather than outright banning coverage.
For information about commercial insurance that is not covered by Out2Enroll, check out Advocates for Trans Equality’s Trans Health Project – their site goes in-depth on legal rights regarding commercial coverage and how to navigate its systems.
Crowdfunding & Grants
In the age of the internet, crowdfunding is a common route many transgender folks use to finance transgender-related surgeries when their primary insurance provider fails them, or they lack coverage entirely. The most commonly used platforms are GoFundMe, Donorbox, and Facebook – although all of these sites take a percentage of the money raised. GoFundMe is the largest crowdsource site, but it’s known to take the largest cut compared to alternatives. Non-personal organizations and nonprofits have a larger variety of sources out there, like Givebutter, while individuals can raise money without losing a percentage through direct money transfer apps like Cash App, Venmo, Paypal, and Zelle.
This option is less advised compared to the above routes – if possible, use any insurance coverage you have and work your way down this list. Personal loans through online lenders and credit unions are the best route for borrowing money for gender affirmation surgery, with their own pros and cons. Online personal loans can be used for nearly any purpose, including medical costs, and range up to $100,000 but can be expensive if you don’t pay attention to your monthly payment and annual percentage rate. Credit unions offer similar personal loans at lower interest rates but use your credit score to determine whether you qualify for their funding.
The most common credit card associated with healthcare costs is CareCredit, which offers zero-interest financing for a designated term. However, the downside to CareCredit is that it defers interest after its promotional period if you fail to finish your payments within that period – and CareCredit’s standard APR is 29.99%. Depending on your credit score, other credit cards offer alternatives with lower interest rates than CareCredit.
Lastly, some surgeons and healthcare providers offer payment plans similar to credit financing that break up large medical bills into more affordable monthly payments. Make sure you read the terms before signing and negotiate with your provider to understand additional billing fees associated with using a payment plan.
Common Gender-Affirming Surgeries
🚻BODY CONTOURING. Associated with: Any/All Genders. Set of surgical procedures that uses liposuction, fat grafting, and skin excision techniques to sculpt the body to appear more feminine, masculine, or androgynous. Can be covered as medically necessary on a case-by-case basis with sufficient documentation of gender dysphoria. Recovery time of two to three weeks, average cost of $8,500 to $19,500 without coverage.
🚺BREAST AUGMENTATION. Associated with: Transfeminine. Surgical procedure that utilizes breast implants to create a female breast contour, especially when combined with estrogen-based hormone replacement therapy. Can be covered as medically necessary, especially if breast contour from HRT is insufficient to alleviate gender dysphoria. Also known as MTF top surgery. Recovery time of four to eight weeks, average cost of $5,000 to $10,000 without coverage.
🚹CHEST RECONSTRUCTION. Associated with: Transmasculine. Surgical procedure that removes the breasts through a variety of techniques to create a male chest. Widely considered medically necessary and is the most common gender-affirming surgery for transmasculine individuals. Also known as FTM top surgery or a mastectomy. Recovery time of six to eight weeks, average cost of $3,500 to $10,000 without coverage.
🚺ELECTROLYSIS. Associated with: Transfeminine. Non-surgical technique that permanently removes hair regardless of hair type or skin color but is slower than laser hair removal (which works best for dark hair and light skin and does not work on blonde, gray, white, or red hair). Widely considered medically necessary and commonly covered with prior authorization. Recovery time of two to three weeks per session, average cost of $30 to $150 per session without coverage.
🚺FACIAL FEMINIZATION. Associated with: Transfeminine. Surgical procedures that transform traditional male facial features into shapes, sizes, and proportions associated with female features. Considered medically necessary. Also known as FFS. Recovery time of six to twelve months, average cost of $4,500 to $100,000 without coverage.
🚹FACIAL MASCULINIZATION. Associated with: Transmasculine. Surgical procedure that masculinizes facial features, especially in individuals who do not receive sufficient masculinization from testosterone through hormone replacement therapy. Can be considered medically necessary with sufficient documentation of gender dysphoria. Also known as FMS. Recovery time of six to twelve months, average cost of $1,000 to $20,000 without coverage.
🚻HAIR TRANSPLANTS. Associated with: Any/All Genders. Surgical technique that creates hairlines associated with male or female stereotypes and restores hair loss. Can be deemed medically necessary but not commonly covered by most insurance providers without sufficient documentation for gender dysphoria. Recovery time of ten days per session, average cost of $4,000 to $15,000 without coverage.
🚹HYSTERECTOMY. Associated with: Transmasculine. Surgical procedures that remove the uterus or womb. Total hysterectomies remove the cervix, although the removal of the ovaries varies based on patient preference and medical need. The three main procedures include laparoscopic, vaginal, and abdominal – while abdominal is the most common, it is the most invasive and has the most associated complications. Widely considered medically necessary. Also known as masculinizing lower surgery or hysto. Recovery time of six weeks, average cost of $16,000 to $17,000 without coverage.
🚺LARYNGOCHRONDOPLASTY. Associated with: Transfeminine. Surgical procedure performed as a type of facial feminization surgery to reduce the size of the Adam’s apple by removing thyroid cartilage. Can be considered medically necessary. Also known as a tracheal shave. Recovery time of two to four weeks, average cost of $3,000 to $10,000 without coverage.
🚹METOIDIOPLASTY. Associated with: Transmasculine. Surgical procedure that creates a small phallus from existing genital tissue formed from clitoral enlargement from testosterone-based hormone replacement therapy. Widely considered medically necessary when accompanied by medical documentation. Also known as meta. Recovery time of six weeks, average cost of $4,000 to $60,000 without coverage.
⚧️NULLIFICATION. Associated with: Nonbinary. Surgical procedure that reroutes the urethra to the perineum to create a gender-neutral appearance to the genitals. Compared to other genital surgeries, gender nullification is relatively new and was introduced as an option due to the growing number of medical professionals well-versed in nonbinary identities. Can be considered medically necessary, although you may have to combat your insurance provider due to it being considered more experimental than other genital surgery options. Also known as nullo or eunuch surgery. Recovery time of six to eight weeks, average cost of $15,000 without coverage.
🚹OOPHORECTOMY. Associated with: Transmasculine. Surgical procedure that removes the ovaries, halting the natural production of estrogen. Considered medically necessary and often done alongside hysterectomies. Recovery time of two to six weeks, average cost of $7,000 without coverage.
🚺ORCHIECTOMY. Associated with: Transfeminine. Surgical procedure that removes the testicles/testes, halting the natural production of testosterone. Widely considered medically necessary and can be done alongside other gender-affirming genital surgeries. Recovery time of two to four weeks, average cost of $2,000 to $8,000 without coverage.
🚺PENECTOMY. Associated with: Transfeminine. Surgical procedure that removes the penis and relocates the urethra to allow the individual to urinate more freely. Considered medically necessary. Recovery time of four weeks, average cost of $8,000 without coverage.
🚹PHALLOPLASTY. Associated with: Transmasculine. Surgical procedure that creates a penis using tissue grafted from another part of the body, such as the forearm or hip. Widely considered medically necessary when accompanied by medical documentation. Also known as phallo. Recovery time of twelve weeks, average cost of $25,000 to $50,000 without coverage.
🚹SCROTOPLASTY. Associated with: Transmasculine. Surgical procedure that creates a scrotum using skin from the labia and a silicone implant, often done in conjunction with other genital surgeries like metoidioplasty or phalloplasty. Considered medically necessary. Recovery time of eight weeks, average cost of $3,000 to $5,000 without coverage.
🚹 SCROTOPLASTY. Associated with: Transmasculine. Surgical procedure that creates a scrotum using skin from the labia and a silicone implant, often done in conjunction of other genital surgeries like metoidioplasty or phalloplasty. Considered medically necessary. Recovery time of eight weeks, average cost of $3,000 to $5,000 without coverage.
🚹URETHROPLASTY. Associated with: Transmasculine. Surgical procedure that repairs and lengthens the urethra during gender-affirming genital surgery to allow the individual to urinate while standing using their new anatomy. Widely considered medically necessary. Recovery time of six weeks, average cost varies based on accompanying procedures.
🚹VAGINECTOMY. Associated with: Transmasculine. Surgical procedure that removes the vaginal lining and closes the vagina, reducing the complications associated with other genital surgeries like metoidioplasty and phalloplasty. Widely considered medically necessary. Recovery time of six to eight weeks, average cost varies based on accompanying procedures.
🚺VAGINOPLASTY. Associated with: Transfeminine. Surgical procedures that transform male genitals into functional and aesthetic vaginas and vulva. Widely considered medically necessary. Recovery time of six to eight weeks, average cost of $20,000 to $30,000 without coverage.
🚺VOICE SURGERY. Associated with: Transfeminine. Surgical procedure that alters the voice to better fit traditional male and female stereotypes. While possible for transmasculine and nonbinary individuals, it is more commonly associated with transfeminine transitions since testosterone-based hormone replacement therapy naturally alters the voice, whereas estrogen-based HRT does not. Can be considered medically necessary. Recovery time of six months, average cost of $5,500 to $9,000 without coverage.
🚺VULVOPLASTY. Associated with: Transfeminine. Surgical procedure that removes the penis, scrotum, and testicles while also creating a labia, clitoris, and urethral relocation – but unlike vaginoplasty, it does not create a vaginal canal and instead has a zero/shallow-depth dimple constructed. Can be considered medically necessary. Recovery time of six to eight weeks, average cost of $20,500 to $22,000 without coverage.
Curious about the basics of gender-affirming care? The use of HRT has been foundational and approved as the best form of treatment for transgender people for nearly a century. Learn the facts about hormone replacement therapy and its importance in this week’s post. Looking for other transgender resources? Click here.
What is HRT?
HRT, also known as hormone replacement therapy, is the use of synthetic hormones to mimic traditional sex hormones. Hormone treatments were originally invented in the early 1900s, related to when researchers discovered how to isolate and synthesize testosterone and estrogen, and became widely prescribed to cisgender folks by the 1960s.
Even though HRT is commonly associated with transgender people and our transitions, it’s utilized more often by cisgender individuals – these hormone treatments were created to help with the lower levels of sex hormones cisgender men and women experience as they age. The use of hormone replacement therapy as gender-affirming care and a means to allow transgender people to medically transition began in the 1950s through the John Hopkins School of Medicine, Harry Benjamin, and Christian Hamburger. Gender-affirming hormone therapy (GAHT)/hormone replacement therapy (HRT) is the use of prescribed synthetic hormones to align one’s secondary sex characteristics with their gender identity – which ranges from body fat, breast growth, muscle mass, vocal range, hair, Adam’s apple, etc.
What are Puberty Blockers?
Puberty inhibitors and blockers suppress the natural production of sex hormones like testosterone and estrogen, created and approved by the FDA to treat precocious puberty in cisgender children. Due to the growing trend of children starting puberty earlier than normal, puberty blockers became more commonplace for doctors to prescribe to cisgender patients. Around the same time, puberty blockers were being used experimentally abroad to help transgender children explore their gender identity more thoroughly by the 1990s via the Dutch Protocol. The primary purpose of puberty blockers is to pause cisgender-associated puberty in youth wanting to explore their gender identity without the use of HRT. After spending an ample amount of time solidifying their gender identity, they can continue their medical transition through hormone replacement therapy to mimic puberty aligned with their internal gender; if they change their mind regarding their gender identity, puberty blockers can be stopped at any time and puberty will begin/resume as normal.
Before continuing, I cannot stress enough that puberty blockers and hormone replacement therapy are widely considered safe by the scientific community. Both treatments have been used to treat gender dysphoria for decades and it’s been established blockers are the best and most humane way to allow gender-diverse children to explore gender since blockers are entirely reversible. The only genuine negative side effect associated with blockers is lower bone density that is created by bone mineralization during puberty – but this is easily managed with exercise, calcium, and Vitamin D. There is not much high-quality research on the long-term effects of puberty blockers, just as there is little long-term research on transgender people as a whole – but information available supports that the use of puberty blockers. Even if all parents/legal guardians approve of a child receiving puberty blockers, many additional steps are required to ensure they are the best option for the child’s health and well-being. Despite this consensus, many bad actors intentionally lie to harm transgender people: it has been leaked and proven that anti-trans politicians are purposely using funds to back pseudo-scientific research against gender-affirming care in their bills. It is incredibly easy for institutions and figures to create misleading research to support inaccurate beliefs; the foundations that host their findings are non-profit, using governmental 501(c)(3) status to legitimize their work even though anyone can create a non-profit by filling the appropriate paperwork. Many organizations have tried to ‘debunk’ puberty blockers and the Dutch protocol out of a political agenda – but none of them can debunk the actual use of blockers in trans children, which is to simply pause puberty temporarily (not ‘cure’ gender dysphoria, force children to take cross-sex hormones, etc.) As such, there are no reputable organizations, institutions, or research groups that dispute the effectiveness of gender-affirming care.
Puberty blockers are most often prescribed for gender-diverse youth between the ages of 9 to 16, but this can vary based on your needs since bodies vary. Once prescribed, blockers come in two forms: the histrelin acetate rod can be inserted under the skin in your arm and lasts for one year, while the leuprolide acetate shot can work up to 1, 3, or 4 months at a time. However, puberty blockers and gender-affirming care for minors are currently highly controversial for reasons stated above – as of 2025, there are six states that make it a felony crime to provide gender-affirming care to transgender youth.
On January 28th, 2025, President Donald Trump signed the executive order “Protecting Children from Chemical and Surgical Mutilation,” which prohibits federal funding and research on gender-affirming care for all individuals under the age of 18 in the United States. On paper, this bans the use of Medicaid, TRICARE, and other government programs from prescribing puberty blockers, hormone replacement therapy, and other well-supported forms of care until age 19. However, this order has long-reaching effects which is why it is being challenged in court – hundreds of hospitals and clinics are preemptively stopping gender-affirming care entirely out of fear, and even more facilities have stopped providing gender-affirming care entirely to all transgender people regardless of age since they rely heavily on federal funding.
I would normally try and insert an information video about puberty blockers – but YouTube is infested with anti-transgender content on the topic due to recent news from both the Trump administration and overseas in the United Kingdom.
Mythbusting HRT: Fact-Checking Gender-Affirming Care
MYTH: GENDER-AFFIRMING CARE IS UNSAFE. FACT: As I mentioned above, gender-affirming care is supported by every major medical and mental health association. Age-appropriate transition care is considered both medically necessary and life-saving for individuals who experience gender dysphoria, or a disconnect between their internal gender identity and sex assigned at birth. While there are some negative health risks associated with hormone replacement therapy that I will cover later, they are immensely manageable and outweighed by the positive impacts of gender-affirming care. Over 1.3 million licensed doctors in the US support gender-affirming care, as well as leading organizations like the American Medical Association, American Academy of Pediatrics, and American Psychological Association.
MYTH: ONLY EXTREMIST LEFTIST DOCTORS SUPPORT GENDER-AFFIRMING CARE. FACT: In the United States alone, over 1.3 million licensed doctors support gender-affirming care. That’s because transgender healthcare is overwhelmingly backed by research! That’s essentially every single registered physician considered active by the American Medical Association. Not every doctor agrees on gender-affirming care, and there are plenty of physicians that are not well-informed on how to interact with transgender patients – but the underlying consensus no matter what is that gender-affirming care is necessary.
MYTH: BUT [INSERT STUDY HERE] SAYS GENDER-AFFIRMING CARE IS DANGEROUS! FACT: Also mentioned above, there is a growing wave of anti-trans pseudoscience being funded by politicians with bigoted and nonscientific agendas. We live in a universe where you can purchase a degree from nonreputable sources, and astroturfing proves how widespread fake movements are in funneling money to bad science. If someone lacks integrity, it is not hard to manipulate research into creating “proof” that supports your claim – most commonly, these individuals will manipulate the data gathered in their research by deleting objecting evidence and using misleading questions. The amount of junk science that opposes transgender rights and healthcare is overwhelmingly outweighed by real researchers and associations – which have real relevant experience, qualifications, peer-reviewed work, and publications by reputable journals.
Lastly, federal law states that insurance providers can limit care, even if it’s deemed medically necessary – but they are not allowed to deny care based on patients. If a provider covers mastectomy for cancer or genetic predisposition, they must also cover it for gender dysphoria. Providers that cover hormone treatments for cisgender people cannot deny HRT for transgender individuals. Doing so is considered discrimination and blatantly against the law.
MYTH: MOST PEOPLE THAT TRANSITION REGRET THEIR DECISION! FACT: Any “research” you read regarding this, I invite you to reread the above section on junk science. Detransitioning, or the act of reverting to your sex assigned at birth, is exceedingly rare and studies report “transition regret” as low as 1% to 2% of all cases – although these numbers vary drastically due to the political slant in the research. In reality, gender-affirming care actually has the lowest regret rates in the medical field – your average major surgery has a 5% to 10% regret rate, knee replacement surgeries have rates up to 30%, and pregnancies have roughly a 7% rate of regret. You wouldn’t dream of preventing someone from having knee surgery or a baby because they might regret it later.
Potential regret is why puberty blockers exist for trans kids. Blockers allow transgender youth to explore their gender identity before medical transition since they’re reversible. Even for adults, gender-affirming care is not someone people just wake up and decide one day. Surgery requires letters of approval from mental health professionals, which can take three to twelve months of appointments to get. While informed consent clinics make it easy for transgender adults to access hormone replacement therapy, they’re still not going to prescribe hormones for someone who “decided” they were trans that same day – they’re going to make sure you have fully thought through your decision and can give medical consent.
MYTH: PEOPLE ARE ONLY BECOMING TRANSGENDER NOW BECAUSE IT’S TRENDY. FACT:Transgender people have existed as long as humanity has existed. We will continue to exist no matter what laws are passed, even if we are forced back into the closet. While more people are open about their transgender identities, it’s not because it’s suddenly trendy – it’s just safer and more socially acceptable to be open about it. Language changes, so more people are able to become familiar with words like transgender to describe their experiences – in the past, people who would identify as transgender today might have identified as drag performers, crossdressers, transsexuals, transvestites, or even butch women and femme men.
The right-wing “social contagion” theory has been repeatedly debunked. The theory asserts that “rapid onset gender dysphoria” occurs in today’s youth due to social media – but there is zero empirical evidence to support this claim. This conspiracy theory is used by lawmakers to justify anti-trans legislation, and most medical associations have made official statements to eliminate this term from being used.
MYTH: CHILDREN SUBJECTED TO GENDER-AFFIRMING CARE HAVE MEDICAL PROCEDURES THAT WILL PERMANENTLY ALTER THEIR LIVES. FACT: News articles that claim this are sensational and intentionally trying to mislead you. Before puberty, transition is entirely social for children – as well as for most adults in the beginning processes of exploring their gender. Social transition involves no medical interventions and therefore is completely reversible, such as using a new name, pronouns, clothing, or hairstyle. The only possible negative consequence of social transition is potential bullying and discrimination – but it is in no way that person’s fault they are being bullied or harmed due to a society that is adverse to exploration.
If a child is exploring their gender identity at the onset of puberty and they have supportive parents, they might have access to puberty blockers to pause puberty temporarily while they continue to explore. Blockers have been approved as the gold standard by the FDA since 1993 to pause puberty. Complications like bone density are easily remedied with supplements and existing research on puberty blockers used on cisgender youth with precocious puberty shows normal fertility and reproductive functioning after reversing their blockers.
There are no young children who are being subjected to transgender-related surgeries. In extremely rare cases, 16 and 17-year-olds can get specific surgeries like chest/top surgery only if they have been consistent in their current gender identity for years, have been taking gender-affirming hormones for an extended amount of time, and have approval from all parents/legal guardians and doctors. Once all of those factors are achieved, they still have to get additional approval from multiple mental health providers and physicians to determine that surgery is the best course of action. By the time that process is done, that young person is most likely 18 – which is why the overwhelming majority of transgender youth wait until that age to pursue gender-affirming care.
The only form of “mutilating” sex surgery performed on children is perpetrated by conservatives. Intersex medical interventions, or genital mutilations, are performed on intersex infants to align with stereotypes on how male and female genitals should look – with or without parental knowledge.
MYTH: ANTI-TRANS BILLS ARE ALL ABOUT PROTECTING KIDS! FACT: Politicians who insert partisan debates in private conversations never genuinely care about science, medicine, or evidence. If these bills were about protecting kids, anti-abortion politicians would ensure the United States has an immaculate foster care system, education program, and policies to uplift youth. Instead, those same politicians have zero empathy for new mothers, purposely try to destroy public education, disavow sexual education entirely, attempt to dismantle foster care systems, create higher costs for giving birth and parenthood, and penalize youth at every possible chance. Anti-trans bills and their lawmakers are fueled by bad faith – politicians that regularly try to defund services like mental health cannot be taken seriously when they try to claim they are “protecting kids.”
There have been clear, well-established, and evidence-based standards of care for transgender people for nearly a century – the World Professional Association of Transgender Health (WPATH) has maintained these standards for decades. These standards advocate that gender-expansive youth have access to socially explore their gender before anything else.
How Do I Get HRT?
There are two primary routes to get prescribed hormone replacement therapy: letter approval and informed consent. Both are acceptable ways to legally get access to hormones – but the path you should take will depend on your needs and local laws.
INFORMED CONSENT
The informed consent model of care is the most modern and reduces gatekeeping that bars many folks from receiving healthcare. The idea behind informed consent is that most adults can make decisions about their own healthcare when given accurate and in-context information. After finding a provider that uses the informed consent model, they’ll educate you on the possible benefits and risks to HRT before having you sign off on the paperwork needed to state you are officially consenting to the medication plan.
To be able to use informed consent, you will need to be your own legal guardian. Most people automatically do this upon turning 18, although your situation may vary. Upon meeting that standard, your provider must feel confident that you understand the information given to you, so they’ll likely break down medical terms and videos, photographs, and guides.
Wanting to find an in-person informed consent provider? Erin Reed has a detailed map and Planned Parenthood is one of the largest providers in the United States. Due to the current administration, it is advised to find a provider you can see in person – political attacks on trans-related telehealth make online options less viable for the immediate future. However, FOLX and Plume are the best telehealth HRT providers that prescribe hormones online.
The greatest pro to informed consent HRT is the speed of the entire process. Some clinics will prescribe you hormones the same day that you make your appointment. A common complaint about the traditional route where you’re required to get a letter from a mental health professional is that trans folks feel like they’re performing their transness for their provider – giving a long story on when they first realized they were transgender, often embedded with many of the stereotypes cisgender people have about transness to get their medication. By removing that barrier, trans people are more free to be themselves.
LETTER APPROVAL
Until 2012 upon the release of WPATH’s 7th edition of the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, the approval letter model was the only way to access hormone replacement therapy – the 7th edition officially opened the path for providers to prescribe HRT through informed consent.
The letter approval model requires transgender people to acquire a letter from a therapist or other mental health professional stating that gender-affirming care like HRT is medically necessary for their well-being. This method is becoming less common since it encourages negative stereotypes about transgender people as they’re forced to cater to the understanding (or lack thereof) of transness that a mental health provider has to receive their letter of approval.
The process can take anywhere from three to twelve months since it requires the therapist to feel fully confident that gender-affirming care is medically necessary for their client before signing the letter. However, the letter approval model is more stable and tends to offer more financial stability – most insurance companies will put up a fight on covering any sort of medical care, and this is definitely the case within transgender healthcare. It’s also worth noting that since the letter approval model is more traditional and has been used for decades, it’s less likely to be impacted by anti-transgender laws or executive orders in the years to come.
Providers that offer gender-affirming care through the letter approval process often work on a much smaller scale and are significantly more common in rural settings. While large gender clinics have specialized staff to prescribe informed consent HRT, these providers may be primary care physicians, endocrinologists, gynecologists, urologists, psychologists, or psychiatrists.
Feminizing Hormone Therapy (FHT)
Feminizing HRT uses a combination of several hormones to create physical changes in the body typically caused by female puberty. Gender-affirming hormones stimulate nearly all of the same changes that occur during puberty for cisgender girls. Most individuals take a combination of estrogen (estradiol) and antiandrogens (spironolactone) since a testosterone-blocking medication is required to ensure the synthetic estrogen works best. While it’s not as common, some providers also prescribe progesterone to aid FHT.
Estradiol is prescribed as a pill, injection, and skin patch. Throughout your healthcare journey, your provider will regularly check your hormone levels with blood tests to ensure they’re in an optimal and healthy range. The effects of FHT vary from person to person – puberty is different for cisgender and transgender people alike, and the best way to predict what your results will be is to look at women you’re immediately related to. The combination of testosterone blockers and estrogen causes breast growth, softer skin, less facial and body hair, decreased muscle mass, and more – but FHT can’t change the pitch or sound of your voice, which is why some people opt for voice feminization surgery or voice therapy.
There is a lack of substantial research on the long-term effects of hormone replacement therapy on transgender bodies – however, it’s important to note in any research that you read regarding the risks that HRT makes your body medically female. Women are more at risk of developing conditions like osteoporosis and osteopenia. Current information about transgender healthcare will reflect this, but older studies are often cited with bad intentions without including this. Genuine risks associated with gender-affirming care include things like infertility and erectile dysfunction. In the event that you wish to pursue parenthood, some transgender people pause their FHT temporarily to increase their fertility – but it’s not guaranteed since the longer you are on HRT, the more likely you are to become permanently infertile. Complications with HRT can be lowered and managed by regularly seeing your healthcare provider.
Masculinizing Hormone Therapy (MHT)
Masculinizing HRT primarily uses testosterone to create physical changes in the body typically caused by male puberty. Gender-affirming hormones stimulate nearly all of the same changes that occur during puberty for cisgender boys. Compared to FHT, only one medication is prescribed – testosterone does not need additional medication used since it naturally overpowers the effects and production of estrogen. That process is the exact reason why FHT tends to require both estrogen and testosterone blockers to have a noticeable effect.
Transgender people are most commonly prescribed testosterone as a shot, skin patch, pellet, or gel. Testosterone also comes in a pill form, but it is not often prescribed as gender-affirming care since its pill variant is harsh on the body long-term. Throughout your healthcare journey, your provider will regularly check your hormone levels with blood tests to ensure they’re in an optimal and healthy range. The effects of MHT vary from person to person – puberty is different for cisgender and transgender people alike, and the best way to predict what your results will be is to look at men you’re immediately related to. Testosterone generally causes facial hair, body hair, voice changes, greater muscle mass, oily skin, possible hair loss, and more – like with FHT, you can’t choose which effects of hormone replacement therapy you’ll receive since it’s based on genetics.
As mentioned above regarding feminizing hormone therapy, there is a lack of substantial research on the long-term effects on transgender bodies. Despite this, gender-affirming care is considered medically necessary and important to provide since it alleviates gender dysphoria and allows transgender people to live as their authentic selves. Many of the associated risks documented in older research on HRT are common health risks that cisgender men are generally more likely to have than women – like high blood pressure, male-pattern baldness, acne, and diabetes. The most typical genuine risk associated with gender-affirming care is infertility; while testosterone may decrease the chance of pregnancy, it is not an effective birth control method and does not fully prevent it. In the event that you wish to pursue parenthood, some transgender people pause their MHT temporarily to increase their fertility – but it’s not guaranteed since the longer you are on HRT, the more likely you are to become permanently infertile. Complications with HRT can be lowered and managed by regularly seeing your healthcare provider.
Nonbinary Hormone Therapy (NHT)
There is no one way to be nonbinary – but some nonbinary people pursue hormone replacement therapy as part of their journey to live comfortably in their own bodies. Compared to FHT and MHT, nonbinary hormone treatments aim to balance the levels of estrogen and testosterone in the body to create an androgynous appearance. The most common route is microdose HRT, or when hormone replacement therapy is prescribed at a much lower dose than traditional levels. Changes take significantly longer to occur but allow the individual to stop more immediately when they are satisfied with the changes. Since it is impossible to directly choose what changes will occur on HRT, this gives a small level of control since the changes associated with HRT are gradual like cisgender puberty.
For individuals assigned female at birth, testosterone is often prescribed at a low dose for a short period of time. Those assigned male at birth may choose to use a low dose of both testosterone blockers and estrogen or opt for just estrogen. In both cases, it is important to remember that not all changes caused by HRT are permanent – some, like voice changes, breast growth, and clitoral growth are permanent while others like fat redistribution, acne, and periods are not.
Further Reading: Learn More About HRT
Cleveland Clinic is a major academic medical center based in Ohio, ranked as one of the best hospitals in the United States. Its site hosts comprehensive information about gender-affirming care for both feminizing hormone therapy and masculinizing hormone therapy.
FOLX Health is the largest HRT telehealth provider in the United States and offers prescribed medication to registered members. Since FOLX has in-person facilities in major cities, it is available in all states – including ones that are banning transgender telehealth like Florida. Learn about their programs for feminizing hormone therapy, masculinizing hormone therapy, and nonbinary hormone therapy.
GoodRx is a free website and mobile app that provides users with discounts on prescription drugs at over 75,000 pharmacies across the United States, including major retailers like Walmart, CVS, Costco, and Kroger. These discounts also apply to medications prescribed for gender-affirming care – GoodRx is the primary alternative for individuals needing prescription medications but does not have insurance coverage to pay for those medications. Due to this, GoodRx is a valuable resource if Medicaid or commercial insurance bans transgender-related healthcare coverage. It also hosts information about both masculinizing hormone therapy and feminizing hormone therapy.
Johns Hopkins Medicine is a teaching hospital and biomedical research facility based in Baltimore’s Johns Hopkins School of Medicine, most well-known for being one of the first gender clinics in the United States. Its Center for Transgender and Gender Expansive Health offers information on a variety of gender-affirming services like hormone replacement therapy, surgery, fertility, voice therapy, primary care, etc.
Planned Parenthood is an American nonprofit reproductive and sexual healthcare provider, which continues to be the largest single abortion provider in the United States. Planned Parenthood is also one of the largest national HRT providers, although not all of their locations offer HRT services. Learn more about some of the gender-affirming services Planned Parenthood provides.
Plume is another large HRT telehealth provider and takes a large range of commercial insurance plans. While Plume operates throughout the majority of the United States, their lack of in-person facilities means they are not able to prescribe HRT to states banning transgender telehealth like Florida. Its site contains a great deal of information on both estrogen hormone therapy and testosterone hormone therapy.
Trans Health Project is a site maintained by Advocates for Transgender Equality (A4TE) to educate transgender people about their legal rights and better access to gender-affirming healthcare. The project contains information on medical insurance, state laws, HRT providers, etc.
University of California San Francisco Transgender Care, also known as UCSF’s Gender Affirming Health Program, is a multidisciplinary program that provides gender-affirming care out of the research university and hospital. Its site contains information on hormone therapy as well as other forms of gender-affirming care like surgery, sexual health, sexual health, and voice therapy.
University of Virginia Health is an academic healthcare center based in Charlottesville and maintains a transgender health clinic. Its site has information on hormone replacement therapy, although its content is not as in-depth as other resources on this list.
Looking for resources to better support yourself or a trans loved one? Everyone deserves to lead happy, healthy, and fulfilling lives.
Author’s Note: This list is not comprehensive – future blog posts will have details on trans resources not included in this article, which serves as a basic intro to trans resources and information. Also, some legal rights and resources contained in this post may change due to the hostile political environment regarding trans lives.
Get Help Now: Crisis Resources
If you are thinking about harming yourself or others, please get immediate support. The National Suicide Prevention Hotline has call, text, and online chat options available for free confidential support 24/7/365 for anyone in crisis.
I’ve previously mentioned various hotlines and mental health resources, outlining how to navigate counseling, support groups, and telehealth options. Remember that anyone can and should use hotline services – there’s no minimum level of “crisis” you have to have to call, and you’re never wasting their time by doing so.
LGBTQIA+ people, and especially transgender and nonbinary individuals, are more likely to become homeless than cisgender heterosexual folks. Queer individuals have less family support than others due to anti-LGBTQIA+ hostility, so they have limited options for doubling up and staying with family during housing instability. Despite sexual orientation and gender identity being included in discrimination protections under federal laws like the Fair Housing Act, queer people are still turned away from potential landlords and houses unless they have the financial means to fight for their legal rights. Due to these factors, queer and transgender people are more prone to engage in survival sex and sex work as a way to find shelter when employment and traditional services are restricted. While homelessness is a crisis of its own, being unhoused individuals are exceedingly likely to experience other crises.
Even homeless shelters are not necessarily safe for LGBTQIA+ people – most shelters in the United States stem from religious charity work that eventually evolved into the modern nonprofit industry that exists today. It’s not exactly uncommon for homeless transgender people to feel unsafe while trying to get help from shelters that discriminate on their gender identity, using gendered binary shelters to designate their arrangements regardless of their gender identity. When shelters require ID, LGBTQIA+ people risk discrimination when gender identity and expression don’t fit their ID or legal name. The best way to combat anti-LGBTQIA+ discrimination is to report an official complaint with the US Department of Housing and Urban Development, which can be filed online, over the phone, or by mail. LGBTQIA+ community centers and organizations local to your area can also be helpful in advocating for your rights.
Unfortunately, there aren’t any comprehensive national directories of LGBTQIA+-friendly homeless shelters. Instead, it’s best advised to look at the reviews of local shelters and ask community members in your region whether they’re affirming of queer and transgender people. Ultimately, the best way to determine whether a homeless shelter or program is LGBTQIA+-inclusive is by calling them directly and asking about their policies. Trans Lifeline cites giving direct support in calling homeless shelters in this manner on behalf of transgender callers for free in the United States.
My previous hotline post covers major LGBTQIA+ hotlines around the world – none of them discriminate based on gender identity, and transgender crisis support is a key aspect of their work. The following hotlines are a condensed LGBTQIA+ version of that post with only national US listings, although many major cities have regional LGBTQIA+ hotlines available in addition to those below.
DEQH provides free confidential counseling to LGBTQIA+ South Asians through trained peer support volunteers. DeQH is the first and only national queer Desi helpline and serves anyone from the South Asian diaspora. They are only available to take telephone calls on Thursday and Sunday evenings, although they can be reached during the week through their online contact form for a reply.
Fenway Health is an LGBTQIA+ healthcare, research, and advocacy organization that also provides free information and referrals for LGBTQIA+ issues, harassment, and violence. Both of their helplines are available during select evening hours from Monday to Saturday: the Fenway LGBT Helpline for individuals ages 25 and older can be reached at 617-267-9001, while the Peer Listening Line for those ages 25 and under can be called at 617-267-2535.
LGBT Switchboard of New York is recognized as the oldest LGBTQIA+ hotline in the world and provides free peer support Monday through Saturday. Despite their name, the LGBT Switchboard of New York offers support, care, resources, and information to anyone regardless of where they live by calling 212-989-0999 – including outside of New York and the United States.
MASGD, or the Muslim Alliance for Sexual and Gender Diversity, operates the Inara Helpline every Friday and Saturday evening for LGBTQIA+ people who identify or are perceived as Muslim. The MASGD Inara Helpline can be reached by calling 717-864-6272.
National Suicide Prevention Lifeline, or the 988 Suicide & Crisis Lifeline, is the largest mental health and crisis hotline in the United States. Using support from the Substance Abuse and Mental Health Services Administration, 988 routes callers to licensed mental health services based on their location to provide 24/7/365 services by calling the general 988 number. The Lifeline is fully accessible in English, Spanish, and American Sign Language (ASL) and also provides services via text/SMS and online chat.
For specifically LGBTQIA+-trained counselors, individuals should press 3 after dialing 988, texting “PRIDE” to 988, or checking the relevant box for LGBTQIA+ support when completing the pre-chat online survey.
SAGE x HearMe is a collaborative project between SAGE, the nation’s largest organization for LGBTQIA+ elders, and HearMe to modernize the national queer senior hotline. SAGE x HearMe operates a mobile app that users can reach anonymously 24/7 to find instant support.
SGR Hotline, or the Sex, Gender, and Relationships Hotline that spun from the LGBTQIA+ Switchboard of San Francisco, provides free confidential counseling on STDs, HIV, pregnancy, birth control, gender identity, sexuality, kinks, sex work, anatomy, and more. Their number at 415-989-7374 is available for callers Monday through Friday.
The Network/La Red is a survivor-led organization that focuses on LGBTQIA+ partner abuse, as well as abuse in kink and polyamorous communities. Their free 24-hour hotline can be fully used by both English and Spanish speakers by calling 800-832-1901 (toll-free) or 617-742-4911 (voice).
The Trevor Project is the primary crisis organization for LGBTQIA+ youth in the United States between the ages of 13 to 24. Their services are available 24/7/365 in collaboration with the 988 Suicide & Crisis Lifeline: The Trevor Project can be reached by phone at 866-488-7386, text/SMS at 678-678, and online chat. TrevorSpace is a moderated online forum available at any time.
Trans Lifeline is a peer support hotline run by trained transgender volunteers for trans, nonbinary, and questioning folks in need of support. Services are fully anonymous, confidential, and do not engage in non-consensual active rescue every Monday through Friday.
THRIVE (Thriving Harnesses Respect, Inclusion, and Vested Empathy) is a text-based crisis line staffed by trained professionals with marginalized identities, catering to people of color, LGBTQIA+ individuals, disabled people, and other vulnerable people. The text/SMS line is available 24/7/365 by texting “THRIVE” to 313-662-8209.
Trans Rights & Me: Legal Resources
The best source for legal information and steps to update legal names and gender markers on identity documents (such as state IDs, driver’s licenses, birth certificates, passports, social security, selective service, and immigration documents) is Advocates for Trans Equality. Their ID Document Center is a one-stop online hub for transgender folks looking to update their information and is the most current national directory of related resources.
The ability to change one’s legal name or gender marker varies by state – so while it may be easy to update identity documents for individuals who were born in California or Oregon, it’s prohibited elsewhere in the country. Federal documents, like passports, can have their gender marker updated despite state law – although this may change due to the current administration.
Get Help: Transgender Legal Organizations
Advocates for Trans Equality operates its Impact Litigation Program to take on a small number of court opportunities each year to establish trans-affirming precedents in the law through the work of the Transgender Legal Defense and Education Fund. Their Trans Legal Services Network represents over 80 organizations throughout the United States that provide legal services to transgender people local to their area.
American Civil Liberties Union is one of the primary human rights organizations in the United States that has fought for individual rights and freedoms since 1920. The ACLU operates chapters in each US state to handle court opportunities and case litigation – individuals should contact their local ACLU chapter for legal assistance. In addition, the ACLU also maintains comprehensive legal resource guides on a variety of topics such as LGBTQIA+ rights, disability, religious freedom, criminal law, racial justice, HIV, reproductive freedom, voting, immigration, free speech, etc.
Black & Pink is an LGBTQIA+ prison abolitionist organization with multiple programs aimed to resettle queer and transgender individuals through transitional housing and opportunities.
Equality Federation is a non-partisan lobby and LGBTQIA+ policy organization that pursues pro-equality legislation throughout the United States. Their legislation trackers include current information on both positive and negative trans-related bills among other queer issues.
Gay and Lesbian Advocates and Defenders is a national litigation organization that takes on several LGBTQIA+ cases to advance queer and transgender rights throughout the country. They also operate their own Transgender ID Project, although it is more limited than A4TE’s. Unlike A4TE, GLAD has a public online contact form for free and confidential legal information, assistance, and referrals.
Gay, Lesbian, and Straight Education Network, or GLSEN, is an education organization that provides support to LGBTQIA+ public students and educators. The GLSEN Navigator directs online users to the most appropriate GLSEN branch/chapter near them and also provides information on local laws, protections, and research. The Public Policy Office also serves as a hub for legal protections and information about previous court cases GLSEN has provided assistance and litigation for.
GLAAD is an American media and legislation nonprofit that serves to create better representation and visibility for LGBTQIA+ in entertainment. The GLAAD Accountability Project provides public information GLAAD collects by monitoring and documenting high-profile figures and groups that use their platforms to spread misinformation and false rhetoric about LGBTQIA+ communities.
Immigration Equality is America’s leading LGBTQIA+ and HIV-positive immigrant rights organization, providing expert guidance on queer and transgender immigration legal policy while also using impact litigation to advance LGBTQIA+ and immigration rights through far-reaching court cases.
International Lesbian, Gay, Bisexual, Trans, and Intersex Association is a federation of 2,000 organizations in over 160 countries around the world dedicated to promoting LGBTQIA+ rights alongside the United Nations. Through their networks, ILGA brings international attention to human rights violations to the UN and media.
interACT is an intersex rights organization centered on youth empowerment, which employs full-time lawyers to fight for intersex bodily autonomy in the United States.
Lambda Legal is a litigation organization that represents the interests of LGBTQIA+ people in the United States alongside the ACLU and GLAD. Like GLAD, Lambda Legal operates a Help Desk to provide general legal information and resources – although their assistance is not legal advice to the same level as GLAD.
National Black Justice Coalition is the leading civil rights organization for LGBTQIA+ Black Americans, offering toolkits and resources in addition to legislation lobbying in favor of pro-equality bills for queer and transgender rights.
National Center for Lesbian Rights is a civil and human rights organization that supports the rights of all LGBTQIA+ people. Despite their name, the NCLR advocates for all queer and transgender rights through litigation, policy, and public education. They also operate a free legal helpline, available at 800-528-6257 and 415-392-6257.
National Gay and Lesbian Task Force is the oldest national LGBTQIA+ rights organization in the United States that collaborates with over 400 organizations in federal policy advocacy to organize census and voting campaigns through FedWatch.
NMAC, or the National Minority AIDS Council, leads HIV policy and legislation related to communities of color in the United States. Their Advocacy 101 section guides users to become politically active and involved in local legislation with their elected representatives.
Outright Action International is an advocacy organization dedicated to LGBTQIA+ human rights around the world that works with the United Nations to develop global programs and initiatives towards creating a safer world for queer and transgender folks.
Pride Law Fund is a funding service that sponsors legal projects, services, education, and outreach that promote LGBTQIA+ people and individuals living with HIV.
Sylvia Rivera Law Project is a collective that increases the political voice and visibility of low-income people and people of color who are transgender, nonbinary, intersex, or gender-nonconforming. SRLP’s programs and legal assistance are geared towards transgender people who are at risk of homelessness, have criminal records, or are immigrants.
Transgender Law Center provides impact litigation on select court cases to advance transgender rights in the United States. TLC also provides basic information about laws and policies through their Legal Help Desk, although they do not take on individual cases through the Desk.
Trans Legislation Tracker is an independent research organization that tracks bills related to transgender and nonbinary people in the United States through the work of academics and journalists who publish the Trans Legislation Tracker’s data.
Looking for more information about legal issues, information, and rights? This resource post can guide you through the basics of legal jargon, rights, important court cases, and general resources.Advocates for Trans Equality also has an extensive database of trans-related protections and laws. Both the Movement Advancement Project and Erin in the Morning have up-to-date maps on LGBTQIA+ laws.
Healthcare is a Human Right
Looking for general healthcare resources? This post outlines what medical care is, how to navigate healthcare insurance, and general resources/programs.
Coverage of gender-affirming care by state government healthcare programs like Medicaid and CHIP varies by state, although the Affordable Care Act prohibits discrimination based on gender identity – which has been further backed by federal courts. This means that all state Medicaid programs have to provide general and gender-affirming healthcare, but each state is allowed to impose specific guidelines or restrictions on having that care paid by Medicaid similar to commercial insurance policies. While some transition-related care can be denied on a case-by-case basis, it has been established that “blanket bans” on transgender care is discriminatory and illegal. However, it’s worth noting that Medicaid access is not equal throughout the United States – 10 states completely deny Medicaid to single adults without children or disabilities. The Movement Advancement Project has an up-to-date map of current Medicaid policies by state and whether gender-affirming care is protected or excluded. A4TE has a directory of Medicaid policies.
On January 28th, 2025, President Donald Trump signed the executive order “Protecting Children from Chemical and Surgical Mutilation.” While executive orders often carry the power of federal law, they do not override the US Constitution, federal statutes and laws, or established legal precedent – nor do they have the longevity of passed laws. The order bans gender-affirming care being covered by state Medicaid programs for anyone under the age of 19, including puberty blockers and hormone replacement therapy.
Federal programs vary, and their consistency is subject to the current presidential administration. Medicare currently covers medically necessary gender-affirming care, which includes hormone replacement therapy, surgery, and related consultations – these are listed under Medicare Part D and should be fully covered when prescribed. Indian Health Services (IHS), which covers Native Americans recognized in federally recognized tribes, implies that gender-affirming care is covered by their programs – although there is less explicit guidance of this practice online. TRICARE, the primary healthcare coverage for active service members and their families, only covers select parts of gender-affirming care like HRT – although this is extremely likely to change in 2025 under the new presidential administration and TRICARE will likely deny all gender-affirming coverage in the event transgender people are banned from military service again. This is similar to coverage provided by the Veterans Health Administration (VHA), which still only covers some transition-related medical care despite early promises made by the Biden administration to lift the bans imposed by Trump’s first administration. Finally, while all incarcerated individuals are entitled to medical care as determined by Estelle v. Gamble, there is no minimum quality of healthcare required as long as the prison offers any form of medical care – and that care does not have to be free, despite popular belief. While gender-affirming care is considered necessary and intentional barriers are seen as a violation of the Eighth Amendment, it is difficult for transgender prisoners to fight for their medical rights while incarcerated. American prisons are not required to be accredited, although one of the main accrediting bodies – the National Commission on Correctional Health Care – supports gender-affirming care for incarcerated individuals. In other words, gender-affirming care for incarcerated transgender people varies drastically based on the facility they are at.
The Trans Health Project, an initiative through Advocates for Trans Equality, is the primary resource for understanding and navigating healthcare insurance and gender-affirming care in the United States as a transgender person. The site guides users through the process of applying for commercial healthcare, understanding their coverage, and navigating the laws in their state. Half of US states explicitly prohibit health insurance companies from excluding transgender-related services, while the other half of the country has no regulations on what services commercial insurance can prohibit.
Most healthcare insurance programs, regardless of whether they are commercial or government-based, have requirements before gender-affirming care can be covered. Reputable programs will base their requirements on WPATH, or the World Professional Association for Transgender Health, which has held the standard for ethical transgender healthcare since 1979. The Standards of Care for the Health of Transgender and Gender Diverse People is used as the international standard for transgender healthcare similar to how the Diagnostic and Statistical Manual (DSM) is the standard used for mental health treatments. WPATH and the SOC have clearly stated that gender-affirming care such as hormone replacement therapy and gender confirmation surgery is the best practice based on scientific research for decades. As such, insurance plans and programs use WPATH and SOC guidelines to require transgender people to have “persistent, well-documented gender dysphoria,” the ability to make a fully informed consent, and a set amount of counseling with a mental health professional to receive a medical necessity letter to submit for insurance coverage. A4TE also provides a free template for users to appeal insurance denials of gender-affirming care. Transgender adults have the option to pursue gender-affirming care out-of-pocket to bypass the restrictions imposed by insurance coverage programs – which is covered in financial resources later in this article.
There are additional restrictions for transgender minors, which is a hot topic in current politics during this heightened war on transgender rights. In states where minors are allowed gender-affirming care like puberty blockers, hormone replacement therapy, or surgery, there are additional requirements and consent must be given by the minor’s parents or legal caregivers. There are currently six states that make it a felony crime to provide gender-affirming care to transgender minors: Oklahoma, Florida, Alabama, South Carolina, Idaho, and North Dakota.
How to Find Gender-Affirming Care
Just like other medical fields, gender-affirming care can be done in-person or through telehealth – in-person providers are more often covered by healthcare programs, but can be more difficult to access than telehealth.
Will gender-affirming care be banned? The current political distribution of Congress, the President, and the Supreme Court has many transgender people rightfully anxious about the future of their care – especially since the GOP has declared war on “transgenderism.”
It’s not impossible – I’m not going to lie to you. There *is* a worst-case scenario out there where transgender people of all ages are denied gender-affirming care and we are given the options to forcibly detransition, become refugees and leave the United States, seek care illegally, or die. However, this scenario is unlikely. The American public has complicated views on transgender topics, but the majority believes that transgender people should have additional rights to protect them from discrimination. The last two elections have shown that American voters are not nearly as gung ho about erasing transgender rights as the GOP is hedging their bets on – which is what ultimately lost the GOP their “red wave” in 2022. While the upcoming years will be rough, we just have to survive two years before Congress can swing back blue – assuming that Democrats have given up claiming they lost the 2024 election due to being “too woke.”
So what’s realistic? Within the next two years, I can easily see Medicaid no longer being able to cover gender-affirming care like hormone replacement therapy or surgery – although any decision to do so would immediately end up in court since it would violate the Affordable Care Act. On the other hand, that’s likely something the anti-trans GOP wants since they want to eliminate the Affordable Care Act and give in to the commercial healthcare industry’s demands. It is something that would rely on Trump – likely an executive order that bars federal funding from any healthcare provider that performs gender-affirming care. While the GOP has a majority in Congress, their majority is extremely slim and fragile due to their own infighting so any massive bill is improbable unless Democrats fold on LGBTQIA+ rights. Don’t get me wrong – that’s no small thing. Medicaid is used by millions of Americans, including myself, but it would be survivable with enough resourcefulness. Out-of-pocket expenses would increase for transgender folks and we would be more likely to rely on older methods of self-prescribed gender-affirming care before the wide access to providers. However, it would be survivable – especially with the likely increase in mutual aid, donations, fundraising, and international support that would come with such a decision. I don’t think it’s realistic that the act of prescribing gender-affirming care to adults will be nationally criminalized or prohibited, as I described in the above worst-case scenario.
IN-PERSON PROVIDERS
The OutList Provider Directory is a free resource through OutCare, a nonprofit health organization that advocates for comprehensive LGBTQIA+ health. The directory provides information about providers from all fields – including HRT and surgery. For best results, search by tag (“gender-affirming medical care” pulls a good number of results) rather than specialties. Other directories also exist, such as Rad Remedy and MyTransHealth, although these other independent projects have not survived the pandemic as well as OutList.
In a similar vein, TransLine is an information and medical consultation service that explains various gender-affirming techniques like HRT and surgery and includes many of the billing codes that providers have to use for care to be covered by healthcare insurance.
Both WPATH and the Gay and Lesbian Medical Association (GLMA) have online directories of healthcare providers that are listed with them. Out of the two, GLMA’s directory is extensively better since its LGBTQ+ Healthcare Directory is larger and more user-friendly. Similarly, TransHealthCare provides information about transgender-specific surgeons in a more user-friendly format than WPATH. While not necessarily listed in the above directories, Planned Parenthood is one of the largest gender-affirming care providers in the US since most of their local health centers provide HRT and puberty blockers in addition to their other services like STD treatment and abortions. Planned Parenthood didn’t used to provide HRT as widely as now before the rise of anti-transgender legislation – although now it’s a focal point and cornerstone of their mission to provide equitable healthcare.
TELEHEALTH PROVIDERS
During the COVID-19 pandemic, an influx of telehealth created a wealth of transgender healthcare accessibility. There are a number of virtual HRT providers that prescribe gender-affirming care.
An important note on gender-affirming telehealth: HRT through telehealth may soon no longer be an option for transmasculine people seeking testosterone. Due to its history of being abused by predominantly cisgender men, testosterone is a highly classified drug compared to the treatment prescribed to transfeminine folks. Even though more than just transgender men use testosterone, COVID-19 opened the doors for testosterone to finally be able to be prescribed (temporarily) through telehealth for transmasculine people. However, in the years following the pandemic, the FDA and state governments have been attempting to shut down the prescription of testosterone through telehealth despite the well-documented benefits of telehealth for transgender communities during this turbulent political time.
Most major cities have gender clinics (described below in informed consent options), which almost always give telehealth options when available. Additionally, Planned Parenthood has telehealth options available for their services like gender-affirming care. The following are the largest purely telehealth HRT providers in the United States.
QueerDoc is the oldest large-scale HRT telehealth provider, although they’re smaller than the following two options. They operate in Alaska, California, Florida, Hawaii, Idaho, Oregon, Montana, Utah, Washington, and Wyoming. They don’t accept insurance, but they offer a sliding scale since you’ll be paying out-of-pocket. Compared to FOLX and Plume, QueerDoc is a worse choice due to the pricing but without QueerDoc, there wouldn’t be a FOLX or Plume.
FOLX Health was started a year after QueerDoc and is the largest telehealth option between themselves, QueerDoc, and Plume. FOLX accepts a number of insurance plans to cover their monthly membership fees, copays, medications, and labs. Since FOLX is large enough to have in-person facilities in major cities, FOLX is available in all states – including ones that are banning trans telehealth like Florida. Unfortunately, neither FOLX or Plume are available for minors to use – you have to be at least 18 in most states to use either service, although a few states have an even higher age requirement of 20.
Plume is the youngest of the three main telehealth options and accepts a range of insurance plans. Plume requires a monthly membership to access their providers, which can be covered by insurance plans alongside the copay required for appointments. Unlike QueerDoc, Plume operates as a telehealth provider in nearly the entire US with limited exceptions in states like Florida that are currently banning transgender-related telehealth.
INFORMED CONSENT
Gender clinics refer to medical centers that specialize in transgender-related care – they were especially popular during the 1960s and 1970s and have made a modern resurgence due to the widespread medical consensus that gender-affirming care is the most appropriate treatment for gender dysphoria. These organizations often use informed consent, a process where hormone replacement therapy (or any other treatment) is prescribed to a patient after discussing the potential risks and benefits of HRT and the patient has signed a legal agreement stating they understand and fully consent to the treatment. Compared to traditional routes of pursuing gender-affirming care, informed consent is much faster – after a couple of consultations with a provider, you can physically have your prescribed medication in a couple of weeks. Informed consent allows transgender adults to make their own decisions about their bodies when given complete and accurate information about HRT.
While A4TE has a list of gender centers, I actually recommend Erin in the Morning’s collection. A4TE’s list is limited to facilities associated with research institutions, teaching hospitals, and academic settings – which are more likely to provide care to transgender minors, but woefully incomplete since thousands of informed consent clinics are community health based and not academic (including Planned Parenthood).
LETTER OF NECESSITY
Outside of gender clinics, traditional healthcare providers like most of those listed in directories like OutList will require a letter before they will begin prescribing hormone replacement therapy. This practice dates back to the previous SOC guidance by WPATH (then known as the Harry Benjamin International Gender Dysphoria Association), which requires individuals to find a therapist or counselor to write a letter stating that HRT was deemed suitable and medically necessary. While mental health counseling is recommended for everyone, the required use of letters bars more transgender people than it helps – trans folks are often led to feel like they have to “perform” their transness to get a letter, adhering to common stereotypes that cisgender people have about trans people.
Most mental health professionals qualify to write a letter, as long as they feel comfortable enough doing so – if they don’t feel comfortable and won’t agree to write a letter on your behalf, they’re likely not a good fit for you as a counselor anyway. After receiving your letter, you’ll take it to your HRT provider and soon be prescribed medication. The largest downside to the letter process is the wait times, since mental health care is already considerably less accessible than other medical fields on top of the fact that most counselors will require at least three to six months of regular visits before they will sign off on the letter. On the other end of the spectrum, the vast majority of insurance companies and programs will require a letter to cover HRT since they need it proven that the care is medically necessary enough to cover. Beyond hormone replacement therapy, other forms of gender-affirming care like surgery almost always require at least one letter (if not more) to have a gender confirmation surgeon see you or for insurance companies to pay for your care.
Community Support
For the majority of trans people, online support is the first step to finding support. Trans Lifeline’s Resource Library has a large selection of online support groups, ranging from general support to marginalized groups like people of color, disability, youth, etc.
Nearly all online spaces and social media platforms have transgender-related spaces – like communities on Twitter and Tumblr, groups on Facebook, subreddits, and Discord servers. There are thousands of them, so it’d be impossible to create an exhaustive list – but here are a few major ones on each platform.
Transgender forums have a LOT of history – before the creation of places like Reddit, independent forum websites were the predominant place where transgender people connected in the 1990s when they were unable to find people easily IRL. They were a modern extension of the underground journals and magazines like Transvestia, Drag, Transgender Tapestry, and FTM International. Even though social media platforms like Reddit and Facebook are the mainstream today, many of these forums still exist if you know where to look for them:
There aren’t many large-scale support group organizations – most national LGBTQIA+ groups tend to lead toward activism, politics, and human rights. PFLAG remains the United States’ largest organization dedicated to supporting, educating, and advocating for LGBTQIA+ people and their loved ones and dates back to 1973. PFLAG has over 400 chapters across the country, each offering regular support through their national resources. Further, PFLAG also has regular virtual meetings and moderated community spaces.
All major cities have an LGBTQIA+ community center of some nature – there are rural towns as small as 15,000 where I live with local queer groups. Urban settings have multiple community centers, queer bars, and other hangouts to find support – finding them is just a matter of searching online for local listings. Trans Resources is a directory of advocacy organizations, legal resources, support and social groups, and other resources – although the site isn’t comprehensive, it lists major organizations.
Beyond support groups, transgender mentorship and letter programs exist to provide folks with an added layer of community.Point of Pride operates a letter program that sends written cards to transgender individuals in need of support, which can be sent to PO Box 7824, Newark DE 19714 where the letters will be received before being sent along. Similar programs exist like the Queer Trans Project (mailed to 3733 University Boulevard W, Suite 216, Jacksonville, Florida 32217), Black and Pink, and the Prisoner Correspondence Project – although the latter two focus on incarcerated LGBTQIA+ people rather than the general public. In contrast, mentorship programs pair individuals with an older or more experienced trans person to help answer questions while guiding you along your journey – some programs include the Sam & Devorah Foundation for Transgender Youth and the Trans Empowerment Project.
Money Matters: Financial Resources
Finances can be a genuine barrier to transgender people’s ability to live authentically as themselves. Without a stable income, it’s difficult to maintain housing or get gender-affirming clothes. Court and legal fees aren’t free – it costs money to update your identity documents to reflect who you are. And of course, you either have to have a healthcare insurance plan that covers counseling and medical bills or be forced to pay for them out-of-pocket.
Resources for employment, housing, and clothes have to be sourced locally through mutual aid networks and community organizations – although this post has some basic resources for low-income individuals.
Legal fees for identity documents can be waived if you qualify based on income.Point of Pride has a list of fee waivers by state, although you’ll want to double-check to ensure your waiver is the most up-to-date method. Most states will use your income itself or other connecting program to determine whether you are eligible – like whether you’re already on government assistance programs like SNAP or Medicaid.
Relatedly, there’s also a growing amount of organizations providing funds to help transgender people move to safer locations to live or access gender-affirming care. Some of these programs include Elevated Access, Trans Justice, TRACTION, and the Trans Continental Pipeline.
Beyond nonprofit and mutual aid funds, many transgender people fundraise to cover their transition costs – especially when their insurance refuses to cover surgery or if they have to unexpectedly move. The most commonly used platforms are GoFundMe, Donorbox, and Facebook – although all of these sites take a percentage of the money raised. GoFundMe is the largest crowdsource site, but it’s known to take the largest cut compared to alternatives. Non-personal organizations and nonprofits have a larger variety of sources out there, like Givebutter, while individuals can raise money without losing a percentage through direct money transfer apps like Cash App, Venmo, Paypal, and Zelle. Out of those options, Cash App is the most widely used underdog since they don’t require a bank account and utilize usernames on their customizable cards, and are easier to navigate with incomes revolving around sex work.
